REPUBLIC OF THE PHILIPPINES

MUNICIPALITY OF MANILA
NATIONAL CAPITAL REGION

AFFIDAVIT OF LOSS

I, John Patrick B. Arazo of legal age, single, Filipino citizen, and a resident of Cainta City,
province of Rizal after being sworn to accordance with the law depose and state that:

1.) I am the holder of identification card with Student No. 2014-00680-MN-0 issued by the
Polytechnic University of the Philippines on 2014 at Charlie Del Rosario Building in the main
campus of the Polytechnic University of the Philippines.

2.) In October of 2018, I lost the foregoing identification card on a public utility jeepney on my
way home after my final departmental examination. I presume this to be case because I only
remove my I.D. card after leaving the campus grounds to avoid the attached lace from getting
tangled during the course of my travel. Further, only on this date do I recall to ever have to need
to present my I.D. card, since the final day of the examination also marked the last day of
required attendance for the semester. The lack of reason to be present within the university
premises has led me to realize that my I.D. card was missing only until several weeks later when I
had to comply with the general clearance for my graduation, and present my I.D. to enter the
campus premises.

3.) Despite diligent efforts exerted in order to find and locate the said identification card; the
same could no longer be found and to the best of my knowledge, is truly lost;

4.) The said identification card has not been confiscated by any officer of the law or the issuing
office or agency due to the violation of any law, statute, order, rule or regulation.

5.) In the event that the lost identification card should hereafter be found or located, I undertake
to forward or surrender the same to the Polytechnic University of the Philippines for appropriate
disposal.

4.) I am executing this affidavit to attest the truth of the foregoing statements and for purposes of
complying with Polytechnic University of the Philippines’ general clearance for graduation in lieu
of the identification card which was lost and whatever legal purposes it may serve best.

IN WITNESS THEREOF, I have hereunto set my hand this 6th day of December, 2018 in the City of
Manila, National Capital Region.

___________________

Affiant
Subscribed and sworn to affirmed before me this 6 th day of December, 2018. The deponent in the
foregoing affidavit exhibited to me the Community Tax Certificate No.
REPUBLIC OF THE PHILIPPINES
MUNICIPALITY OF MANILA
NATIONAL CAPITAL REGION

AFFIDAVIT OF LOSS

I, John Patrick B. Arazo of legal age, single, Filipino citizen, and a resident of Cainta City,
province of Rizal after being sworn to accordance with the law depose and state that:

1.) I am the holder of identification card with Student No. 2014-00680-MN-0 issued by the
Polytechnic University of the Philippines.

2.) The foregoing identification card was in my possession from the time of issuance but
sometime on September 2018, the same was lost.

3.) Despite diligent efforts exerted in order to find and locate the said identification card; the
same could no longer be found and to the best of my knowledge, is truly lost;

4.) The said identification card has not been confiscated by any officer of the law or the issuing
office or agency due to the violation of any law, statute, order, rule or regulation.

5.) In the event that the lost identification card should hereafter be found or located, I undertake
to forward or surrender the same to the Polytechnic University of the Philippines for appropriate
disposal.

4.) I am executing this affidavit to attest the truth of the foregoing statements and for purposes of
complying with Polytechnic University of the Philippines’ general clearance for graduation in lieu
of the identification card which was lost and whatever legal purposes it may serve best.

_________________________________

Affiant

SUBSCRIBED AND SWORN to before me this 6th day of December, 2018 in Sta. Mesa, Manila.

Doc. No. ___________;

Page No. ___________;
Book No. ___________;
Series of ___________.