REPUBLIC OF THE PHILIPPINES)

CITY OF CEBU . . . . . . . .) S.S.

AFFIDAVIT OF LOSS

I, RUWELL TEJADA YANEZA, of legal age, Filipino, single and presently residing in C1-
5C 8 Newtown Condominium Mactan, Lapu-Lapu City, Cebu, Philippines, after having been
duly sworn in accordance with law deposes and state:
1. That I am an alumni of University of Rizal System- Morong Campus;

2. That I was given a Diploma issued by the above-mentioned school;

3. That I usually kept my Diploma to an envelope for safe keeping;

4. However the abovementioned item was lost in my possession last August 2010, I
cannot be sure where I have placed it the day it was lost and I have a feeling that I
have misplaced it somewhere the last time I brought it;

5. That despite diligent search and effort exerted to locate the said Diploma, the same
proved futile hence, the same should now be considered lost;

6. I am executing the instant Affidavit to attest the veracity of the foregoing statements
and for the issuance of a new Diploma in lieu of the lost one.

IN WITNESS WHEREFORE, We have hereunto affixed our signature this 23 rd day of August,
2022, at Cebu City, Philippines.

RUWELL TEJADA YANEZA

33-7794933-8
Social Security System

SUBSCRIBED AND SWORN to before me, a notary public for and in the City of Cebu,
this 23rd day of August, 2022 at Cebu City; affiant who personally appeared before me with
their competent evidence of identity above, and who signed this instrument in my presence,
and avowed under the penalty of law to the whole truth of its contents.

WITNESS MY HAND AND SEAL on the date and at the place above-written.

Doc.No._____;
Page No.____;
Book No.____;
Series of 2022.