REPUBLIC OF THE PHILIPPINES)

________________________________) S.S.

AFFIDAVIT OF LOSS

I, PATRICIA SARMIENTO, Filipino, of legal age, and a resident of 123

Hiyas St., Brgy. Sampaguita, San Pedro City, Laguna, having been duly sworn in
accordance with law, hereby depose and state:

1. That I am a high school alumna of XYZ school located at Mango St.,

Brgy. Poblacion, San Pedro City, Laguna;

2. That I attended the school from year 2015 to 2019;

3. That I was issued a high school diploma upon my graduation in the

year 2019 by the school;

4. That despite diligent search and efforts to locate the said high
school diploma, I could not find it such that I believe that it is now
lost beyond recovery;

5. That I am executing this Affidavit of Loss to attest to the truth of

the foregoing and to support my application for the issuance of an
original and/or a certified true copy of my high school diploma in
lieu of the one that was lost.

IN WITNESS WHEREOF, I have set my hand this

________________________, at _________________________ Philippines.

PATRICIA SARMIENTO
Affiant

SUBSCRIBED AND SWORN to before me this day of

______________________ at _________________________ Philippines the affiant is
personally known to me and exhibiting to me her
_______________________________.

Doc No. _____;

Page No. _____;
Book No. _____;
Series of 2023.