REPUBLIC OF THE PHILIPPINES)
PROVINCE     OF    LAGUNA)
MUNICIPALITY OF CALAUAN ) S. S.
                                AFFIDAVIT OF LOSS
       I, EUGENE ANGELES MARTIN, Filipino, 28 years old, single, and presently
resident at Brgy. Balayhangin, Calauan, Laguna, after having been duly sworn to before
competent authority hereby depose and say:
       1. That I am in possession of Diploma issued by DAYAP NATIONAL HIGH
          SCHOOL MABACAN ANNEX, graduated year 2011;
       2. That I found out that my Diploma was missing sometime in the month of
          August 2019;
       3. That notwithstanding thorough and diligent efforts that I have exerted to
          locate my diploma, I could not find it nor locate the same and in all
          probability the same has been lost and can no longer be recovered;
       4. That I executed this Affidavit to attest to the fact of loss and to request
          DAYAP NATIONAL HIGH SCHOOL MABACAN ANNEX to issue a new
          diploma in my name and for whatever other legal purpose this may serve;
      IN WITNESS WHEREOF, I have hereunto affixed my signature this 17th day of
October 2019 at Calauan, Laguna.
                                              EUGENE ANGELES MARTIN
                                                           Affiant
                                             PHILHealth No: 01-051979746-7
    SUBSCRIBED AND SWORN to before me a Notary Public for the Municipality of
Calauan, Bay, Los Banos and in the City of Calamba Laguna with office address at 2/F,
Villaran Building, Alvela St., Brgy. Kanluran Calauan Laguna, this 17 th day of October
2019 personally appeared the above named affiant showing to me ID and avows under
penalty of law to the whole truth of the contents thereof.
                                           ATTY. ALDRIN P. ALIMBUYOG
                                           NOTARY PUBLIC
                                           2F, Villaran Building, Alvela St. Brgy.
   Doc. No. _______                        Kanluran, Calauan,Laguna
   Page No. _______
   Book No._______                         Roll. No. 73376
   Series of 2019                          IBP. 088585/LAGUNA
                                           PTR No. 7391498 /07-09-19 / Calauan,
                                           Laguna
                                           MCLE: Newly admitted to the BAR
                                           Email Address;
                                           aldrinalimbuyog1@gmail.com
                                           Cellular Phone No. 09565207359