REPUBLIC OF THE PHILIPPINES}

Tacloban City, Philippines …............} SS.

AFFIDAVIT OF LOSS

I, xxxxxxxxx, Filipino, female, single, 26 years old, and a resident of xxxxxxxxxxxxxxxx, under oath,
hereby depose and say:

1. THAT I am a graduate of Bachelor of Arts (Social Sciences) in Economics from the University of
the Philippines Visayas – Tacloban College (“UPVTC” for brevity), Tacloban City in 2017;

2. THAT on 14 July 2017, I was able to secure a Certificate of Non-Issuance of Honorable Dismissal
from UPVTC;

3. THAT before June 2022, my residential address was previously located at

____________________, and all my important documents were then situated in the said address;

4. THAT on or about June 2022, my family moved to a different residential house located at
_________________;

5. THAT on or about the same date of our transfer to our new residential house, I have discovered
that my Certificate of Non-Issuance of Honorable Dismissal from UPVTC went missing. I exerted diligent
efforts to locate the said certificate but to no avail, and therefore considered the same as lost and can no longer
be found; and

6. THAT I am executing this affidavit to attest to the truth of the foregoing facts and to use the same
for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I hereunto affix my signature this 22 nd day of December 2022 at Tacloban
City, Philippines.

Xxxxxxxxxxxx
Affiant

SUBSCRIBED AND SWORN to before me this ___ day of December 2022 at Tacloban City,
Philippines, Affiant exhibiting to me as competent proof of her identity her
________________________________ issued at _________________ on __________________.

Doc No.: __
Page No.: __
Book No: __
Series of 2022.