Republic of the Philippines)

City of Manila) S.S.

x-------------x

AFFIDAVIT OF LOSS
I, Michaella Maria Cruz Funelas, Filipino, of legal age, single, and a resident of Sampaloc
Manila, after being duly sworn in accordance with law, depose and state:

That as a bona-fide student of Pamantasan ng Lungsod ng Maynila, I was issued a Student

Identification Card (ID) No. 2013-02079;

That to my surprise, I discovered last September 29, 2016 that the said Identification Card
could not be found;

As all efforts to find the same proved unrewarding, it is now safe to conclude that recovery of
the same is an impossibility;

Thus, I execute this affidavit to establish its loss and to support my application for the
issuance of a new Identification Card.

IN WITNESS WHEREOF, I have hereunto set my hand this October 3 at Quezon City,
Philippines.

Affiant

SUBSCRIBED AND SWORN TO before me this ____ day of ____________ 2015

in Makati City. The affiant, whom I identified through the following competent evidence of
identity: _______________, valid from ______ to ______ issued by _______________,
personally signed the foregoing instrument before me and avowed under penalty of law to the
whole truth of the contents of said instrument.

Doc. No. …….

Page No. ……. Notary Public
Book No. ……
Series of 2015.