Republic of the Philippines)

In the City of Baguio . . . . .) s.s.

AFFIDAVIT of LOSS

I, ________________, of legal age, single, Filipino Citizen and a

resident of Baguio City, after having been duly sworn to in accordance with law
do hereby depose and state:

1. That I am a third year medical student at Saint Louis University Baguio;

2. That I was issued a school ID card with No. ______;
3. That on ________, I discovered that my school ID card was missing.
4. That despite diligent efforts, I could no longer locate the same;
5. That said school ID card was not confiscated by the authorities of school
by reason of any violation of rules and regulations;
6. That I further attest to the truth of all the foregoing facts and to request
for a replacement of said school ID card.

IN WITNESS WHEREOF, I have hereunto set my signature this 9th day of

June 2018, in the City of Baguio, Philippines.

Affiant

SUBSCRIBED AND SWORN to before me this ____ day of June, 2018 at

Baguio City, Philippines. Affiant personally appeared and vouched that all the
foregoing declarations are true to the best of his personal knowledge.