Republic of the Philippines )

Province of Southern Leyte ) s.s.

Municipality of Tomas Oppus )
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AFFIDAVIT OF LOSS

I, JOHN CARLO D. DOMAEL, of legal age, single, Filipino and a resident of Brgy.
San Isidro, Tomas Oppus, Southern Leyte, after having been duly sworn to in accordance with
law, hereby depose and say:

1. That I was enrolled at Southern Leyte State University, College of Teacher Education,
San Isidro, Tomas Oppus, Southern Leyte last SY 2018-2019 and such I was issued a
school clearance every end of the semester;

2. That sometime in December 2019, the aforementioned School Clearance got lost and
nowhere to be found;

3. That exhaustive efforts were exerted to locate the same but my search proved futile as I
could not locate the same up to the present; and

4. That I executed this affidavit in order to attest to the truth and veracity of the foregoing
and for whatever legal intents and purposes this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 19 th day of February 2020 in the
Municipality of Tomas Oppus, Southern Leyte, Philippines.

JOHN CARLO D. DOMAEL

Affiant

SUBSCRIBED AND SWORN to before me this 19th day of February 2020 in the
Municipality of Tomas Oppus, Southern Leyte, Philippines. Affiant personally known to me.

Atty. DON VALDE SALA A

NOTARY PUBLIC FOR THE PROVINCE
OF SOUTHERN LEYTE
Doc. No. 162 Commission Control No. 2020-10; Until Dec. 31, 2021
Page No. 34 Roll No. 70454
Book No. VIII IBP OR No. 095056; 11/18/2019
Series of 2020.
PTR No. 7257637; 12/20/2019
MCLE Compliance No. VI-0027850