Republic of the Philippines)

La Trinidad, Benguet) s.s

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AFFIDAVIT OF LOSS

I, Marvin G. Pagaspas, of legal age, Filipino, single and resident of Km. 4,

Capjaran, La Trinidad, Benguet after having been duly sworn to in accordance with law,
do hereby depose and state THAT:

1. My older, brother MHARCEL A. PAGASPAS, was bonafide holder of

College Nursing Diploma duly issued by University of the Cordilleras;

2. The said College Diploma of my brother was kept inside of our house together
with other important documents. However, sometime lately, my brother
requested us to find and search said diploma as part of the requirements of his
application with the DFA for further authentication. We therefore exerted due
diligence and tried to search immediately in the premises to locate for the same
but it was nowhere to be found. I also asked my housemates and family
members about it but they have no knowledge of its whereabouts. In view of
my earnest efforts to find the said diploma, however, my efforts prove futile,
he therefore considered it loss and beyond recovery without negligence on his
part whatsoever;

3. My brother’s College Diploma has not been intentionally lost by him, but due
to the afore cited reason;

4. I am executing this Affidavit to plead and request the University of the

Cordilleras to issue a new College Diploma in lieu of the lost one. That, I
hereby bind myself to fully excuse University of the Cordilleras for any
damage or liability that it may incur for the issuance of the requested Diploma;

5. Finally, I am executing this affidavit to attest to the truthfulness of the

foregoing facts and for all legal intents and purposes it may serve well.

IN WITNESS WHEREOF, I have hereunto set my hand this 14th day of April
2021 at La Trinidad, Benguet, Philippines.

Marvin G. Pagaspas
Affiant
Valid ID No. A01-18-002029

SUBSCRIBED AND SWORN to before me a Notary Public for and in La

Trinidad, Benguet, Philippines this 14th day of April 2021 by the above Affiant personally
known to me of his identity and identified by to be the same person who personally
signed before me the foregoing Affidavit.

ATTY. CYRUS C. CALAYA

Doc. No. 480; Notary Public until Dec. 31, 2021
Page No. 97; PTR No. BGTCF6233420; Jan. 4, 2021
Book No. II; IBP Lifetime No. 08051, at Pasig City
Series of 2021. Roll No. 52590, May 12, 2006; Manila
S & B Bldg., FA 224, Km. 4
National, Highway La Trinidad, Benguet