Republic of the Philippines )

XXXXXX ) S.S.

AFFIDAVIT OF LOSS OF HONORABLE DISMISSAL

KNOW ALL MEN BY THESE PRESENTS:

I, XXXXX, of legal age, Filipino, married, and a resident of, XXXXX, after
having been sworn in accordance with law, hereby deposes and states the
following:

1. That I was issued an Honorable Dismissal by the XXXXX last XXXXX;

2. That sometime in XXXXX, my family and I transferred residence from

XXXXX, XXXXX;

3. That on XXXXX, I discovered that a few of our personal belongings as well

as a folder bearing family important documents which includes the said
Honorable Dismissal were left behind at our former residence;

4. That I went back to our old residence to locate the same but all those
belongings were nowhere to be found;

5. That despite diligent efforts to locate the same I further discovered that
the said items are irretrievably lost and can no longer be found despite
diligent efforts;

6. That I execute this affidavit to attest to the truth of the foregoing.

Signed on the date and at the place indicated below.

XXXXX
Affiant

SUBSCRIBED and SWORN TO before me on the date and at the place

indicated below. The affiant exhibited to me his competent evidence of identity
as indicated above.
Signed this ______________at ________________, ______________________,
Philippines. WITNESS MY HAND AND SEAL.

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