Republic of the Philippines) Province of Albay ) Sc.

Municipaity of Daraga )

Affidavit of Loss
I, JOHN ROBERT DIG, a Filipino citizen, of legal age, and a resident of Market Site, Daraga, Albay, after having been duly sworn to in accordance with law, hereby depose and state: 1. Albay; 2. That as such, I was issued by the said institution of an Identification Card for school year 2012-2013; 3. That when I am preparing my requirements for enrollment for this school year 2013-2014, I noticed that the aforementioned Identification Card is not where I usually keep the same; 4. That despite thorough search made in order to locate the same, said efforts proved futile and hence said Identification Card issued in my name for school year 2012-2013 can now be deemed lost for all intents and purposes; 5. That I am executing this Affidavit to attest to the truth of the foregoing statements and for whatever legal purpose that this may serve. Affiant further sayeth naught. IN WITNESS WHEREOF, I have hereunto set my hand this ___th day of June, 2013 at Daraga, Albay, Philippines. That I am an incoming Third Year Student of Bicol College, Daraga,

JOHN ROBERT DIG Affiant SUBSCRIBED AND SWORN TO before me this ______th day of June 2013 at Daraga, Albay, Philippines by the affiant who exhibited to me his PNP ID Number 12A200219 as competent evidence of identity in accordance with Rule 2, Section 12(a) of the 2004 New Rules on Notarial Practice, as amended.

NOTARY PUBLIC
Doc. No. _____; Page No. ____; Book No. ____; Series of _____.