REPUBLIC OF THE PHILIPPINES)

PROVINCE OF PANGASINAN ) S.S.

MUNICIPALITY OF LINGAYEN )

AFFIDAVIT OF DAMAGE

I, MICHELLE SANTOS DE GUZMAN, of legal age, Filipino, and a resident of

#24 Heroes Street, Brgy. Poblacion, Lingayen, Pangasinan after having been duly sworn
to in accordance with law, do hereby depose and say:

1. That I attended college at the University of Pangasinan from 2006 to 2010;

2. That as such, I graduated from the above stated University;

3. That being a graduate of the said University, I was issued a diploma;

4. That after time passed by, the said diploma issued to me slowly became
fragile;

5. That due to its frequent transfer from folder to folder, the said diploma
incurred damages;

6. That I am executing this affidavit in order to attest to the truth of all the foregoing,
as basis for the issuance of a new college diploma, and for all legal purpose it may serve.

FURTHER, AFFIANT SAYETH NAUGHT.

MICHELLE SANTOS DE GUZMAN

Affiant
Professional Regulation Commission
Registration No. 0664744
Valid until 03/14/2023

SUBSCRIBED AND SWORN to before me this ___ day of January, 2023 by

affiant, who exhibited to me her government issued ID written below her name, to be the
same person who presented and personally signed before me this affidavit and attested
that the contents thereof are true and correct; and that she voluntarily executed the same.

Doc. No.__
Page No.__
Book No.__
Series of 2023.