Republic of the Philippines )

City of _____________ ) s.s.

x-----------------------------x

AFFIDAVIT OF LOSS

I, ________________________, of legal age, Filipino, single and a resident

of ____________________________________, after having been sworn to in
accordance with law, do hereby depose and state that:

1. I am currently working as the ___________ of

__________________________ with office address at
_______________________;

2. As the ___________ of ___________, I am the holder of the School

documents of __________________________

3. graduated at ___________________________, from which I received

diploma for the degree of Bachelor of Science in Business Administration;

4. On or about the _______________________, I discovered that the said

diploma was lost while I was arranging my things in my room;

5. I exerted diligent efforts to locate the said diploma but all efforts proved
futile as the same could no longer be found;

6. I have given up the said diploma as lost for all legal intents and purposes;

7. I am executing this affidavit to attest to the truth of the foregoing loss for
whatever legal worth this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this

________________________ at Davao City, Philippines.

___________________________
Affiant

SUBSCRIBED AND SWORN to before me in the City of Davao this

__________________________, by affiant who exhibited to me her
__________________________ and that she is the same person who personally
signed the foregoing affidavit before me and acknowledged that she executed the
same.

Doc. No. _____;

Page No. _____;