REPUBLIC OF THE PHILIPPINES)

PROVINCE OF LA UNION ) Sc.

MUNICIPALITY OF TUBAO )
x-------------------------x

AFFIDAVIT OF LOSS
I, MYRNA TAVAS DIAZ-GAZMIN, of legal age, married, Filipino and a resident
of #417 Orchid St., San Antonio, Gerona, Tarlac, Philippines, after having been duly sworn to
in accordance with law, do hereby depose and state the following to wit:

1. That I graduated from Pangao-aoan Elementary School at Pangao-aoan East,

Aringay, La Union in 1979 and was issued an Elementary Diploma;

2. That the said diploma was kept in my personal files together with some other
important documents in my cabinet drawer;

3. Then there came a time that when I needed my Diploma to meet a requirement,
I found out that my diploma was lost;

4. That I exerted my best efforts to locate the same to no avail;

5. That the said Diploma is now considered lost and beyond recovery;

6. That I am executing this Affidavit to attest to the truth of all the foregoing facts
in support of my request for the issuance of a new copy of my diploma from
Pangao-aoan Elementary School and for all other legal intents and purposes
this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 8th day of September
2022 at Tubao, La Union, Philippines.

MYRNA TAVAS DIAZ-GAZMIN

Affiant
CRN: 0002-3090630-1

SUBSCRIBED AND SWORN to before me this 8th day of September 2022 at Tubao,
La Union, Philippines, by the affiant appearing personally and who is known to me to be the
same person who executed this affidavit.

ATTY. JOONEE RANDYL E. RIVERA

Notary Public until December 31, 2022
Doc. No.: 195; Aspiras Highway, Francia Sur, Tubao, La Union
Page No.: 39; Roll No. 61766, TIN 929-347-628
Book No.: XXXIX; PTR No. 6677008, 01-03-22, Tubao, LU
Series of 2022. IBP Life Member No. 012553; 01-02-14, SFLU
Commission No. ANC-2020-70
MCLE No. VII-0004258, 07/21/21