REPUBLIC OF THE PHILIPPINES )

CITY OF BINAN )S.S

AFFIDAVIT OF LOSS

KNOWN ALL MEN BY THESE PRESENTS:

I, CARL JAMES OLAIS, of legal age, Filipino, single, and a resident Ilang-Ilang
St., Ireneville Subd., Brgy. San Francisco, Binan City, Lagunna , after having been
sworn in accordance with law, hereby deposes and states the following:
1. I am the holder/owner/possessor of the documents: GRADE 11 CARD FROM
COLEGIO DE SAN PEDRO;
2. This GRADE 11 CARD FROM COLEGIO DE SAN PEDRO shall be used to
release my diploma and other necessary legal documents from Colegio De San
Pedro:
3. I have recently discovered that the said item/s is/are irretrievably lost and can
no longer be found despite diligent efforts to locate the same;
4. I execute this affidavit to attest the truth of the foregoing.
IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of
_______________. 2021 at Binan City, Laguna.

CARL JAMES OLAIS

Affiant

SUBSCRIBED AND SWORN to before me, this ____ day of August, 2020 in Binan
City, Laguna, with affiant exhibiting his Barangay ID No GBC-10293,Issued on
10/10/2021 at Binan City, Laguna.

NOTARY PUBLIC

Doc. No. : ________;

Page No. : ________;
Book No. : ________;
Series of 2021.