Republic of the Philippines ]

Province of Bohol ]
Municipality of Carmen ] S.S.

AFFIDAVIT OF LOSS
(Re: High School Diploma)

I, CASIMERO B. TEMPLA JR., Filipino, of legal age, married and a resident of

Poblacion Sur, Carmen, Bohol, Philippines, after being duly sworn in accordance with law,
hereby depose and say:

1. That I am a high school graduate of ST. ANTHONY ACADEMY CARMEN INC.

formerly Saint Anthony’s Academy at Carmen, Bohol, last 2002;

2. That I was then given by the said school of a High School Diploma;

3. That said High School Diploma got lost last January, 2022;

4. That I exerted diligent efforts to find and recover the aforesaid High School Diploma,
however, my efforts proved futile as until now, its whereabouts still could not be
ascertained, hence, I considered it to be lost for all intents and purposes;

5. That the said High School Diploma was not transferred to any person for
consideration or used as collateral to secure obligations;

6. That I execute this affidavit voluntarily to attest to the truth of the foregoing
statements to support my request for the issuance of another High School Diploma in
lieu of the lost one;

7. That further, I execute this affidavit for whatever legal purpose this may serve.

IN WITNESS WHEREOF, I hereunto set my hand this 7th day of March, 2022 at
Carmen, Bohol, Philippines.

CASIMERO B. TEMPLA JR.

Affiant
Driver’s License No. G03-18-001672
Issued by Land Transportation Office (LTO)

SUBSCRIBED AND SWORN TO before me this 7th day of March, 2022 at Carmen,
Bohol, Philippines.