Republic of the Philippines)

City of __________________ )SS

AFFIDAVIT OF LOSS OF COLLEGE DIPLOMA

I, (NAME OF AFFIANT), single/married, of legal age, Filipino, residing

at (Address of Affiant), after being duly sworn to in accordance with law, do
hereby depose and say that:

1. I finished my secondary (high school) education at the (NAME OF

SCHOOL) and graduated thereat in (Year of Graduation);

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

3. Last (Date of discovery of loss), I discovered the loss of the said college
diploma from among my belongings;

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

5. In the event that the said college 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 employment.

IN WITNESS WHEREOF, I have hereunto affixed my signature this (Date

of Signing), at (Place of Signing), Philippines.

(NAME OF AFFIANT)
Affiant

SUBSCRIBED AND SWORN TO before me this (Date of Signing) in Cebu

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