REPUBLIC OF THE PHILIPPINES)

City of Batangas)S.S.

AFFIDAVIT OF LOSS

I, LIRIO BARTOLOME ABEL, married, of legal age, Filipino and resident of

Batangas City after being duly sworn to in accordance with law, depose and state THAT:

1. I am an alumnus of Batangas National High School of batch 1998;

2. I was issued a Diploma by the said school upon graduation, under my maiden
name, Lirio Almadin Bartolome;
3. I kept the said diploma, together with my high school grades, specifically Form
137A, and other personal documents, in an envelope and placed it in one of
the cabinets in our house;
4. Lately, while I was organizing my school records and other personal documents
as requirements for my job application, I discovered that the said high school
diploma and Form 137A were missing from the cabinet;
5. All diligent efforts to locate the said diploma and Form 137 turned futile; hence,
I now consider the same as lost and beyond recovery;
6. As such, I am executing this Affidavit of Loss to attest to the truth of the
foregoing facts and to request for reissuance of the above-mentioned Diploma
and High School Form 137A.

IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of

______________ 2022 at Batangas City, Philippines.

LIRIO BARTOLOME ABEL

Afffiant

SUBCRIBED AND SWORN TO before me this ____ day of ______________

2022 at Batangas City, affiant exhibiting to me her Passport ID No. P4133548B valid until
05-Jan-2030.

Doc. No. _____;

Page No. ____;
Book No. ____;
Series of 2022.