AFFIDAVIT OF LOSS

Republic of the Philippines ) SS.

Quezon City, Metro Manils)

I, CHERICH JOYCE T. MACARAEG, of legal age, single and

residing at _______________________________Quezon City, Metro
Manila, Philippines, after being duly sworn, deposes, and says:

That I am the holder of a High School Diploma issued by Lorma

Special Science High School, Lorma Colleges, National Highway,
Urbiztondo, San Juan, la Union.

That after a thorough searched was conducted in all possible

location where it might be placed, the aforesaid Diploma can no longer
be located.

That this affidavit was undertaken to attest to the truth of the

foregoing and to support my request for a replacement of a duplicate
copy of my diploma from Lorma Special Science High School, Lorma
Colleges.

IN WITNESS WHEREOF, I hereunto set my hand this ____ day

of September 2021 at Quezon City, Metro Manila.

CHERISH JOYCE MACARAEG

Affiant

CTC No. ____________________

Issued At ___________________
Issued On

SIGNED IN THE PRESENCE OF:

___________________________ ________________________

Subscribed and sworn to before me in _________, Quezon City,

Philippines this _____________ day of ____________________,
20____.
_______________________
Notary Public
My commission expires on _____________, 20____
Page No. __________________
Reg. No. __________________
Doc. No. __________________
Series of __________________