Republic of the Philippines

City of Lipa

AFFIDAVIT OF LOSS

I, Krislyne M. Ocampo, married, of legal age, Filipino, residing at

Brgy. Inosluban, Lipa City, after being duly sworn to in accordance with law,
do hereby depose and say that:
1. I finished my tertiary education (college) at Lipa City Colleges and
graduated thereat in Year of 2006;

2. As such, I was issued a college diploma by the said school;

3. Last December 2022, I discovered the loss of the said diploma from
among my belongings;

4. Efforts were exerted to locate and recover the said diploma, but in
spite of diligent search, the same cannot be located and is now beyond
recovery;

5. In the event that the said high school diploma should hereafter be
found or recovered, I undertake to forward or surrender the same to
the said school, for its appropriate disposal;

6. I am executing this Affidavit to attest to the truth of the foregoing and

to support a request for replacement copy of the abovementioned
diploma in connection with my application for various employment.

IN WITNESS WHEREOF, I have hereunto affixed my signature

this ____ of January, at Lipa City, Philippines.
 

 
                                                                           KRISLYNE M. OCAMPO
                                                                                     Affiant            

  SUBSCRIBED AND SWORN TO before me this ___ day of January in

Lipa City, affiant exhibiting to me his competent evidence of identity by way
of: PRC ID.
 
 
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of _____.