Affidavit of Loss School ID Sample

REPUBLIC OF THE PHILIPPINES) CITY OF MANDAUE )S.S.

AFFIDAVIT OF LOSS

I, VAN ALLEN MATTHEW G. OSUGAY, 12 years of ae, F!"!#!$o, s!$"e a$% a res!%e$& Pa'$aa$, Ma$%a(e C!&y, af&er a*!$ +ee$ %("y sor$ &o !$ a--or%a$-e !& "a, ere+y %e#ose a$% s&a&e THAT 1. I a/ a 0ra%e  s&(%e$& s&(%e$& of Sa!$& Sa!$& ose# ose# A-a%e/y3Ma$ A-a%e/y3Ma$%a(e4 %a(e4 2. I as !ss(e% !ss(e% a S-oo" S-oo" ID !& !& No.555555555 No.55555555555555, 55555, !- !- I a"ays a"ays ear !$ o!$ &o a$% fro/ &e s-oo"4 6. Las& as& Fe+r e+r(ar (ary 78, 2719 719, I a*e fo($ o($% o(& (#o$ reaea-!$ !$ o/e &a &a& &e a+o*e/e$&!o$e% s-oo" ID as "os&4 8. I& !s /y +e"!ef +e"!ef &a& &e sa!% sa!% ID as as "os& !"e !"e I as r!%!$ r!%!$ a :ee# o$ /y ay o/e o/e fro/ s-oo"4 ;. I e
VAN ALLEN MATTHEW G. OSUGAY

 Aff!a$&  Aff!a$&

SUBSCRIBED AND S=ORN TO +efore /e &!s 9 &  %ay of Fe+r(ary 2719 a& Ma$%a(e Ma$%a(e C!&y, C!&y, P!"!## P!"!##!$es !$es,, aff!a$& aff!a$& +e!$ #erso$a #erso$a""y ""y '$o$ '$o$ &o /e a$% e<!+!&!$ e<!+!&!$ !s ID, as -o/#e&e$& e*!%e$-e of !%e$&!&y ($%er &e 2778 RULES OF NOTARIAL PRACTICE.

Do- No. 55555555  Pae No. 5555555  Boo' No.5555555  Ser!es of 2719.