AFFIDAVIT OF LOSS OF ID CARD

Rev: 30 March 2019

REPUBLIC OF THE PHILIPPINES }

BATANGAS CITY, BATANGAS} S.S.

AFFIDAVIT OF LOSS

I, Jake Ashly B. Chan, of legal age, Filipino, with residence and postal address
at C-145 Anilao East, Mabini, Batangas, after having been duly sworn to in accordance
with law hereby depose and state that:

1. I am presently enrolled in University of Batangas Senior High School

Department;
2. By virtue of my enrollment, I was issued an Identification Card;
3. Said Identification Card was lost sometime on September 26, 2019
at my boarding house in De Joya Subdivision, Alangilan, Batangas City;
4. Hereunder are the facts and circumstances surrounding the loss of my
Identification Card:
The torrents of the rains were heavy during that time and as I was about to
sojourn to the school premises to my hurry, my ID accidentally slipped off
my pocket.
5. I made diligent search to recover the said Identification Card but proved
futile;
6. For all legal intents and purposes the said Identification Card is now
considered lost and beyond recovery;
7. I am executing this affidavit to attest to the truth of the foregoing and for
whatever legal purpose/s it may serve.

FURTHER AFFIANT SAYETH NAUGHT.

IN TRUTH THEREOF, I have hereunto set my hand this 2nd day of October
2019, at Batangas City, Philippines.

Jake Ashly B. Chan

Affiant

SUBSCRIBED AND SWORN to before me this 2nd day of October 2019 ,

affiant exhibited to me his/her Residence Cert. No. 04-22000678 issued at Batangas City
on October 1, 2019.

NOTARY PUBLIC

Doc. No. 28; ATTY. JAERO P. GARCIA

Page No. 5; Roll of Attorneys No. 46776
Book No. XIII; PTR No. 2801881/Batangas City/01-03-17
Series of 2019 IBP Lifetime No. 1011201/Batangas City
MCLE Compliance No. V-0022932;07-11-16