REPUBLIC OF THE PHILIPPINES )

PROVINCE OF ZAMBOANGA DEL SUR)

MUNICIPALITY OF MOLAVE )ss
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AFFIDAVIT

I, DOMENIC L. SUERT, Filipino, of legal age, single, and a resident of Purok 1

Guitran, Dumingag, Zamboanga del Sur, Philippines, after having been duly sworn to in
accordance with law, hereby depose and state, THAT:

1. I am a bonafide student of Josefina Herrera Cerilles State College (JHCSC),

Dumingag Campus, S.Y. 2010-2014;

2. I graduated on April 3, 2014, at JHCSC, Dumingag Campus, with a degree of

Bachelor in Elementary Education;

3. It is my intention to request JHCSC, Dumingag Campus, to request another

issuance of my diploma due to instances that my diploma was used and
submitted for employment purposes;

4. I am executing this affidavit to prove the veracity of the facts mentioned

herein and to support of my application for another issuance of my Diploma.

IN WITNESS WHEREOF, I have hereunto set my hand this 6 th day of October

2015, in Molave, Zamboanga del Sur, Philippines.

DOMENIC L. SUERTE
Affiant
PRC ID No. 1321364
Valid Until: 12/12/2017

SUBSCRIBED AND SWORN to before me this 6 th day of October 2015, in

Molave, Zamboanga del Sur, Philippines.

Doc. No.: 35;

Page No.: 7;
Book No.: IX;
Series of 2015.