Republic of the Philippines)

Province of Southern Leyte) s.s.

Municipality of Tomas Oppus)
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AFFIDAVIT OF LOSS

I, NIMFA B. TIEMPO, of legal age, single, Filipino and a resident of Brgy. San
Juaquin, Macrohon, Southern Leyte after having been duly sworn to in accordance
with law, hereby depose and say:

1. That I was a former student of Southern Leyte State University College of Teacher
Education, San Isidro, Tomas Oppus,Southern Leyte;

2. That I was last enrolled on the 2nd semester of school year 2007-08- I was issued
Honorable Dismissal and other pertinent school records/forms;

3. That sometime in year 2016, the aforementioned Honorable Dismissal and other
pertinent school documents, got lost and nowhere to be found;

4. That exhaustive efforts were exerted to locate the same but my search proved
futile as I could not locate the same up to present;

5. That I executed this affidavit in order to attest to the truth and veracity of the
foregoing and for whatever legal intents and purposes this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 22nd day of February 2019 in
the Municipality of Tomas Oppus, Southern Leyte, Philippines.

NIMFA B. TIEMPO
Affiant
(PRC ID No. 0791571)

SUBSCRIBED AND SWORN to before me this 22nd day of February 2019 in the
Municipality of Tomas Oppus, Southern Leyte, Philippines.