Republic of the Philippines )

City of Manila ) S.S.

AFFIDAVIT OF LOSS

I, VITO GERARDO R. SALES, of legal age, Filipino, single, and resident of

1206 Unit 3 Marian Townhomes, Estrada corner Espiritu Street, Malate
Manila, after being duly sworn according to law, hereby depose and state
that:

1. I am the holder of a student ID with ID Number 11380942 issued by De

La Salle University;
2. Sometime in 22 April 2017, I lost the above student ID under the
following circumstances: I left the taxicab which I was riding on my way
home coming from the dormitory where I was staying during the
weekdays;
3. Despite diligent efforts exerted, I could no longer locate, find or recover
the said Student ID, and to the best of my knowledge, the same is truly
lost;
4. The said student ID 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 student ID should hereafter be found or
located, I undertake to forward or surrender the same to the De La
Salle University for appropriate disposal;
6. I am executing this Affidavit to attest to the truth of the foregoing
statements and to request the issuance of a new [Insert name of
item/document/paper] in lieu of the one which was lost.

IN WITNESS WHEREOF, I hereunto affix my signature this 25 th day of

April 2017 at the City of Manila, Philippines.

____________________________
VITO GERARDO R. SALES

SUBSCRIBED AND SWORN to before me this 25 th day of April 2017

affiant exhibited to me his Drivers License with Drivers License No. E04-08-
005060 issued at Naga City on 3 September 2014.

NOTARY PUBLIC

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