REPUBLIC OF THE 

PHILIPPINES )
Municipality of Sergio Osmeňa, Sr. ) SS.

AFFIDAVIT OF LOSS

I, GEMMA MAGSALAY JUMALON, Filipino, of legal age, married, and a

resident of Sinai, Sergio Osmeňa, Sr.,Zamboanga del Norte under oath, state:

1. THAT I am a graduate of Bachelor in Elementary Education (BEED) of Saint

Vincent College in Dipolog City in the year 1987;
2. THAT by virtue of the said degree, I was issued with a Diploma and Transcript
of Records (TOR), bearing the name GEMMA MAGSALAY, by Saint Vincent
College;
3. THAT sometime in 1990 at our house in Sindangan, Zamboanga del Norte, I
discovered that I lost the said College Diploma and Transcript of Records and
other documents;
4. THAT I exerted diligent efforts to locate the said College Diploma and
Transcript of Records but to no avail and I therefore considered the same as
lost and can no longer be found;
5. THAT I am executing this Affidavit to attest to the truth of the foregoing facts,
for the re-issuance of College Diploma and Transcript of Records, in lieu of
the lost one and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I hereunto affix my signature this ___________ at

Sergio Osmeňa, Sr.,Zamboanga del Norte, Philippines.

GEMMA MAGSALAY JUMALON

Affiant
VIN:7214-0013B-11764GMJ20000

SUBSCRIBED AND SWORN to before me this _________________ at Sergio

Osmeňa, Sr.,Zamboanga del Norte, Philippines affiant exhibited to me her valid proof of
Identity as above-stated.

ATTY. EARL RUSSELL S. PAULICAN

Notary Public
Until December 31, 2021
Roll No. 75530
PTR No. 2182651, 1/04/21, Dipolog City
TIN # 472-022-138
Notarial Commission No. SN: ZDN-DPL-042-2020

Doc No. ________;

Page No. _______ ;
Book No. _______;
Series of 2021.