REPUBLIC OF THE PHILIPPINES )
CITY OF DAVAO             ) S.S.
                                  AFFIDAVIT OF LOSS
       I, ______________, of legal age, Filipino, and a resident of ______________________,
Philippines, after having been duly sworn to in accordance with law, hereby depose and say,
THAT:
       1. I am a graduate of Davao Merchant Marine Academy College of Southern
          Philippines, Tigatto Road Buhangin, Davao City in 2012.
       2. I was issued a Diploma and Transcript of Record by the said school.
       3. The said documents are inside a wood cabinet. Sometime in March 2020, we noticed
          that the papers stored in the cabinet were destroyed by termites and now damaged
          beyond recovery, despite the best effort exerted in trying to restore it.
       4. I am executing this document voluntarily and hereby faithfully narrate the actual
          circumstances surrounding the matter based on my personal knowledge and being the
          person exercising custody over the said documents.
       5. Finally, I am executing this affidavit for the purpose of informing the authorities
          concerned about the fact of loss of the above-mentioned Diploma and Transcript of
          Record and for whatever purpose it may best serve.
       IN WITNESS WHEREOF, I have hereunto affixed my signature this 4th day of
February, 2021at Davao City, Philippines.
                                                                 CCCCCCC
                                                                 Affiant
       SUBSCRIBED AND SWORN TO before me this 4th day of February, 2021 at Davao
City, Philippines by Affiant who exhibited to me his Driver’s License with Number L02-20-
003843, as his competent evidence of identity.
Doc. No. __;
Page No. __;
Book No. __;
Series of 2021.