REPUBLIC OF THE PHILIPPINES )

JAEN, NUEVA ECIJA ) S.S.

AFFIDAVIT OF LOSS

I, EVELYN A. PANGILINAN, of legal age, Filipino citizen, and

resident of Barangay San Roque, Jaen, Nueva Ecija, after having been duly
sworn to in accordance with law, hereby depose and state:

1. That I am the holder of a COLLEGE DIPLOMA issued by

ARAULLO UNIVERSITY under my maiden name EVELYN B.
ANTONINO, which I had acquired on March 28, 1992 after
successfully graduating from the course of Bachelor of Elementary
Education (BEED).

2. That on October 2015, while I was in the hospital taking care of my

son who was confined at the time, a significant flash flood inundated
the Municipality of Jaen, including Barangay San Roque where our
house was situated.

3. That the flood severely damaged and swept away all of our
appliances and official documents, including the aforementioned
COLLEGE DIPLOMA. Despite making diligent efforts to salvage
and locate the said diploma, I was unsuccessful in recovering it.

4. That despite my earnest efforts, I was unable to recover the

COLLEGE DIPLOMA.

5. That I am executing this Affidavit to attest to the truth of the

foregoing statements and to request for the issuance of a new
COLLEGE DIPLOMA in lieu of the lost one.

IN WITNESS WHEREOF, I have hereunto set my hand this 24th day

of June 2024, in Jaen, Nueva Ecija, Philippines.

EVELYN A. PANGILINAN
Signature of Affiant

SUBSCRIBED AND SWORN to before me this 24th day of June

2024 at Jaen, Nueva Ecija, affiant exhibiting her Philippine Passport. I
certify that I personally examined the affiant and that he/she voluntarily
executed the foregoing affidavit and understood the contents thereof.