Republic of the Philippines)

DONE: CITY OF BAGUIO…..) S.S.

AFFIDAVIT OF LOSS
I, ROBELYN B. FELIS, of legal age, single, Filipino Citizen with residence
and postal address at Pico, La Trinidad, Benguet, after having been duly sworn
to in accordance with law do hereby depose and state that:

1. I finished my Bachelor of Science in Nursing at Pines City Colleges

(PCC), hence, I was issued a COLLEGE DIPLOMA;

2. However, the aforementioned DIPLOMA was lost. I am not sure how it

was lost. I look for the said diploma as I needed, however, I could not
locate it anymore. Maybe it was inadvertently thrown away or just
misplaced;

3. I exerted diligent efforts to locate the said DIPLOMA but the same
could no longer be found;

4. The said DIPLOMA has not been given nor pledged to anyone for any
purpose whatsoever, nor was it taken or confiscated by the authorities
for any violation of any law;

5. I am executing this affidavit to attest to the truth of my foregoing

statements and to secure new DIPLOMA in lieu of the lost one and for
all legal intents and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 15 th day of

May, 2019 at Baguio City, Philippines.

ROBELYN B. FELIS
Affiant
PRC Lic. No. 0645151
Valid Until: 9-20-2019

SUBSCRIBED AND SWORN TO before me this 15th day of May, 2019 at

Baguio City, Philippines. Affiant personally appeared and to be the same
person who executed this instrument as her free act and deed.

MODESTO T. ANDONG
Notary Public
Commission No. 39-NC-18-R/Until: Dec. 31, 2019
PTR No. 3954050/1-3-2019/Baguio City
IBP No. 02793/1-3-2019
Roll No. 31289/5-15-81/Manila
Doc. No. 62; MCLE COMPLIANCE No. VI-0000192/June 14, 2016
Page No. 13; BIR TIN No. 121-017-652
Book No. 36; No. 19, 2nd Floor Old Market Bldg.,
Series of 2019. Magsaysay Ave., Baguio City, Philippines

AFFIDAVIT OF LOSS