Republic of the Philippines )

City of Mati, Davao Oriental) Ss

AFFIDAVIT OF LOSS
I, xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx, Filipino, of legal
age, married, and a resident of
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx,
under oath, state that:

1. I am the holder of a University of Southeastern

Philippines (USEP) College Diploma;

2. Last December 4, 2012, during the onslaught of

Typhoon Pablo, our residence in
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx was not spared and
all our belongings were left in topsy-turvy;

3. After such incident, we were able to organize our

belongings; however, my USEP diploma could no longer be
found despite diligent search. Thus, it is now considered lost
and beyond recovery;

4. In addition, yesterday, June 3, 2024, as I was

looking for my driver’s license card, I could not find it in my
wallet;

5. Last week, I remembered seeing my toddler

playing with my wallet but I was not paying much attention
to her at that time which made me believe that she could
have taken the same and lost it;

6. I exerted diligent efforts to locate my driver’s

license but to no avail and I therefore considered the same as
lost and beyond recovery;

7. I am executing this Affidavit to attest to the truth

of the foregoing facts and to use the same for whatever legal
purpose it may serve.
 IN WITNESS WHEREOF, I hereunto affix my signature
this June 4, 2024 in the City of Mati, Davao Oriental.

xxxxxxxxxxxxxxxxxxxxxxxxxxxx
Affiant
Nat’l ID No. xxxxxxxxxxxxxxxxxxxxxxxxxxx

SUBSCRIBED AND SWORN to before me this June 4,

2024 at the City of Mati, Davao Oriental, affiant, personally
appeared and exhibited to me his competent proof of identity as
exhibited above.

Doc No. xx;

Page No. xx
Book No. xx;
Series of xx.