Republic of the Philippines

Province of Cagayan }
City of Tuguegarao } Sc.
x-----------------------------------x

AFFIDAVIT OF LOSS
I, DOMINGO D. TAMAYAO, of legal age, single, and a resident
of Gosi Sur, Tuguegarao City, Cagayan, under oath, depose and
states:

1. That after I exerted my earnest effort, I was not able to locate

my High School Diploma ;

2. That my High School Diploma was kept in our family house at

Gosi Sur, Tuguegarao City while I am currently staying at
Centro 2, Tuguegarao City near my work place;

3. That sometime on September 2018 during the rampage of

Typhoon Ompong, our house was damaged and water came
inside causing some of our things to be damaged or destroyed;

4. That after the typhoon and with my absence, my family

members started to clean our house and threw the things that
they believed were destroyed or useless;

5. Unfortunately, my High School Diploma was included in the

things that was threw away;

6. That I learned this information after I went home in our house

to look for it and asked my family members where my High
School Diploma could be;

7. That I am executing this Affidavit to attest to the foregoing

statements and to secure another Passport and for whatever
legal purpose it may serve.
 AFFIANT FURTHER SAYETH NAUGHT

IN WITNESS WHEREOF, I have hereunto set my hand

this 30th day of November 2018 at Tuguegarao City,
Cagayan.

DOMINGO D. TAMAYAO
Affiant

SUBSCRIBED AND SWORN to before me this _______ day of

December 2018 at Tuguegarao City, Cagayan, the affiant exhibiting
to me his
__________________________________________________________________
______________________________________________________________.

Page No._____
Doc. No.____
Book No._____
Series of 2018