REPUBLIC OF THE PHILIPPINES)

CITY OF PARAÑAQUE ) S.S.

AFFIDAVIT OF LOSS
I, WILLIAM C. SUAZO, of legal age, married, Filipino Citizen, and with residence and postal address at
Purok Poinsettia, Candatag, Malitobg, Southern Leyte, after having been sworn to in accordance with law,
do hereby depose and state:

1. That I am a High School completer at Gordon Heights National High School situated at Gordon
Heights Olongapo City, Zambales of the School Year 2004-2005, whereas granted me High School
Diploma in the same batch;

2. That on February 8, 2022 (Tuesday), around 6PM, our house was caught on fire due to the live
wirings in our area and burned our belongings including the said diploma;

3. That efforts were exerted to obtain the said Diploma, however in spite of diligent ways, it could not
be obtained and the same is now beyond recovery;

4. That I am executing this affidavit for testifying that the said Diploma was lost;

5. Finally, I am executing this affidavit to attest to the truth of the facts stated above, to notify the
authorities of such fact, for re-issuance for a new one and for whatever legal purposes this may
serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 27th day of May, 2022 in the City of
Parañaque, Philippines.

WILLIAM C. SUAZO
Affiant

SUBSCRIBED AND SWORN to before me, this 27th day of May, 2022 in City of Parañaque,
Philippines. Affiant exhibited to me his: NATIONAL ID – 6087-4196-8140-5306 .

Notary Public
Doc. No. _______
Page No. _______
Book No. _______
Series of 2022.