REPUBLIC OF THE PHILIPPINES )

CITY OF SAN CARLOS (PANG.) ) SS.

AFFIDAVIT OF LOSS

I, Angela , of legal age, Filipino, single and a resident of ____, , after having been duly sworn to in
accordance with law, do hereby depose and say:

1. That I finished my Secondary Education from Ednas School of San Carlos City Pangasinan and
graduated thereat in 2007;
2. As such, I was issued a High School Diploma by the said school;
3. On February 2020, I discovered the loss of said high school diploma from my belongings
4. That inspite of my diligent efforts to locate the whereabouts of my said diploma, all my
efforts are in vain, hence considered lost;
5. That I am executing this Affidavit of Loss freely and voluntarily and to make it known further
to all authorities concern.

IN WITNESS WHEREOF, I hereunto set my signature this ___ day of February 2020 at San Carlos
City Pangasinan.

ANGELA SORIANO

ID NO.

SUBSCRIBED AND SWORN to before me this _____ day of February 2020 at San Carlos City
Pangasinan.

DOC. NO. ___ ATTY. ARACELI L.

MARTINEZ
PAGE NO. ___ NOTARY PUBLIC
DOC. NO. ___ UNTIL DEC. 31, 2020
SERIES OF 2020 IBP OR NO. 1251
1/9/20
PTR OR NO. 6931641
1/14/20
MCLE NO. V-
0004278
ROLL NO. 30, 343