AFFIDAVIT OF LOSS OF IDENTIFICATION CARD

REPUBLIC OF THE PHILIPPINES)

__City of Manila__ _ ) SS.

I, Chad Jorel V. Hernandez , Filipino, of legal age, and a resident of 1231 Asturias Street, Sampaloc
Manila, after having been duly sworn in accordance with law, hereby depose and say:

1. That I am a holder of a school identification card bearing serial number 2011-031689 issued by UST
Office for Student Affairs;

2. That I used to put said identification card in my pouch.

3. That sometime on April 14, 2018, when I arrived home from work, I discovered that my
school/company ID card was no longer in my pouch where I used to place it;

4. Despite diligent search and efforts to locate said document, I could not find it.

5. That said school/company ID card was not confiscated by the authorities of school by reason of any
violation of school rules and regulations;

6. That I am executing this affidavit to attest to the truth of the foregoing facts and to request for a
replacement of said school ID card from Mr. Pedro Dela Cruz

IN WITNESS WHEREOF, I have hereunto affixed my signature this 16th day of _April_ 2018_ at
Manila_, Philippines.

________Chad Jorel V. Hernandez____

(Signature of Affiant over Printed Name)

SUBSCRIBED AND SWORN TO before me, this 16th day of _April 2018. The affiant, whom I
identified through the following competent evidence of identity: Driver’s License ID No. 1234567, valid
from 2017 to 2020 issued by LTO Philippines, personally signed the foregoing instrument before me
and avowed under penalty of law to the whole truth of the contents of said instrument.

Notary Public

Doc. No. ........;

Page No. .......;
Book No. .......;
Series of 2018.