Republic of the Philippines)

C I T Y O F T A N J A Y )s.s.

AFFIDAVIT OF LOSS

I, DIONISIO M. PATRIARCA JR., of legal age, Filipino, with residence

and post-office address at Manipis, Tanjay City, Negros Oriental, Philippines,
under OATH, depose and say:

That I am the holder of High School Diploma who graduated high

school on March, 1989 at East Negros Institute, now Diaz College, Tanjay
City, Negros Oriental;

That unfortunately, her High School Diploma issued by said school

was misplaced in our residence at Manipis, Tanjay City, Negros Oriental;

That I exerted all my efforts in finding my High School Diploma but all
my efforts exerted were all in vain;

That I am executing this affidavit in order to attest to the truth and

veracity of the above facts and to declare the lost of my High School
Diploma issued by East Negros Institute, now Diaz College.

IN WITNESS WHEREOF, I hereunto set my hand this 2nd day of July,

2019 at Tanjay City, Negros Oriental.

DIONISIO M. PATRIARCA JR
Affiant
Driver’s Licence No. P0828-17067-20302
 SUBSCRIBED AND SWORN to before me this 2nd day of July, 2019 at
Tanjay City.

Doc. No.______;
Page No.______;
Book No.______;
Series of 2019 .