REPUBLIC OF THE PHILIPPINES)
Province of Sorsogon ) S.S.
Municipality of Gubat )
AFFIDAVIT OF LOSS
I, xxx, Filipino, of legal age, single, residing at xxx, after having been sworn
in accordance with law hereby depose and state that:
1. I am the true and lawful owner of a diploma issued by the XXX for earning
my degree in XXXX when I graduated in XXX (hereinafter referred to as
“college diploma”);
2. Sometime in XXX, typhoon Ondoy hit Metro Manila and I was then living in
my rented apartment in Parañaque, Metro Manila. During this time, my
apartment was flooded and several of my personal belongings were carried
away by the flood water;
3. When the floodwater subsided, I discovered that my college diploma was
missing. Thus, I went through my personal belongings and files, but I could
not locate my college diploma;
4. Diligent search of my college diploma in my personal belongings that re-
mained in my apartment proved futile and unavailing. Hence, I reached the
conclusion that my college diploma is lost beyond recovery; and
5. I am executing this affidavit to attest to the truth of the foregoing and to re-
quest for the issuance of another diploma from the XXX in XXXX.
IN WITNESS WHEREOF, I have hereunto set my hand this XXX in XXX,
Philippines
XXX
Affiant
SUBSCRIBED AND SWORN to before me, this ___________ in
_______________ with affiant exhibiting his PRC ID No. ______________ issued
on ___________ at _____________ and expiring on ______________.
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2019.