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.