REPUBLIC OF THE PHILIPPINES )

CITY OF CALAMBA )S.S

AFFIDAVIT OF LOSS

KNOWN ALL MEN BY THESE PRESENTS:

I, PRINCESS REYES, of legal age, Filipino, single, and a Blk 27, Lot
2, GK Majada In, Brgy. Canlubang, Calamba City, Laguna, after having been
sworn in accordance with law, hereby deposes and states the following:
1. I am the holder/owner/possessor of the documents: FORM 137 AND
HIGH SCHOOL DIPLOMA FROM CAMP VICENTE LIM
NATIONAL HIGHSCHOOL;
2. 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;
3. I execute this affidavit to attest the truth of the foregoing.
IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of
_______________. 2022 at Calamba City, Laguna.

PRINCESS REYES
Affiant

SUBSCRIBED AND SWORN to me before me this ____ day of

___________, 2022 the affiant personally appeared and exhibited his
competent evidence of __________.

Doc No. ________

Page No. _________
Book No. __________
Series of 2022.