REPUBLIC FO THE PHILIPPINES}

CITY OF MANILA }S.S.

X-----------------------------------------------X

AFFIDAVIT OF LOSS

I, ALEANA BANTOLO, of legal age, single, Filipino, and a resident of Sta. Mesa, Manila,
under oath state:

1. I am the holder of Ateneo Law School ID No. 123456 issued on June 3, 2018;
2. On March 19, 2019, I went to the comfort room on the second floor of the Ateneo
Professional Schools to brush my teeth;
3. Prior to brushing my teeth, I removed my ID which was then clipped to my breast pocket
and I placed the ID on the sink;
4. After brushing my teeth, I hurriedly left the comfort room because I was running late for
my 1:00pm class;
5. During the class, I recalled that I left my ID in the comfort room;
6. After my class ended at 4:00pm, I went to the comfort room to look for my ID but it was
nowhere to be found;
7. I am executing this affidavit in support of my application for a new student ID;
8. I have nothing further to date.

Signed on April 26, 2019 in the City of Makati.

ALEANA CECILIA P. BANTOLO

Affiant

SUBSCRIBED AND SWORN before me a notary public in the City of Manila on April 26,
2019, affiant exhibited to me her LTO Driver’s License No. 123456, which is valid until December
1, 2020 and bears his photograph and signature.

Soc. No. ____;

Page No. ____; NOTARY PUBLIC
Book No.____;
Series of 2019.