REPUBLIC OF THE PHILIPPINES )

PROVINCE OF TARLAC ) S.S.

MUNICIPALITY OF CAMILING )

AFFIDAVIT OF LOSS

I, JAY-AR ALCANTARA DAMASO, 27 years old, married, Filipino

citizen and a resident of Barangay #34 Barangay Cub-cub, Mayantoc,, Tarlac,
Philippines, after having been duly sworn to in accordance with law, do hereby
depose and state THAT:

1. I finished my secondary education at the Luciano Millan National High

School, Poblacion East, Asingan, Pangasinan on April 2007 and I was
issued by the said school a Diploma upon graduation;

2. I kept the said diploma, together with other personal documents, in an

envelope and placed it in one of the cabinets in our house;

3. Lately, while I was organizing my school records/documents, I

discovered that my high school diploma was missing from the cabinet
where I was keeping it. Thus, I tried to locate the said diploma in the
other cabinets and drawers inside our house where the said diploma
might have been kept and/or transferred but I found nothing. I also
asked the members of my household if they have seen the same but all
answered in the negative;

4. All my diligent efforts to locate the said diploma turned futile; hence, I
now consider the same as lost and beyond recovery;

5. I am executing this affidavit to attest to the truth of the foregoing

statements and for all legal intents and purposes it may serve.

IN WITNESS WHEREOF, I hereunto affixed my signature this 28th day

of July, 2017 at Camiling, Tarlac, Philippines.

JAY-AR A. DAMASO
Affiant

SUBSCRIBED AND SWORN to before me on the date and place

indicated above. Affiant exhibited to me his PhilHealth ID Card with PIN: 07-
025857542-1 issued by the Philippine Health Insurance Corporation.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2017.