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Affidavit of Loss for Form 137

1. Vianca Kaye G. Cruz is applying for an International Student Exchange program that requires her Permanent School Record (Form 137) from Nueva Ecija Dominican Academy where she graduated in 2011. 2. She can no longer find her Form 137 after making earnest efforts to locate and search for it in her old school files. 3. As the Form 137 cannot be found or recovered, she is executing this Affidavit of Loss to attest that the form is lost and request its replacement from Nueva Ecija Dominican Academy.

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100 views1 page

Affidavit of Loss for Form 137

1. Vianca Kaye G. Cruz is applying for an International Student Exchange program that requires her Permanent School Record (Form 137) from Nueva Ecija Dominican Academy where she graduated in 2011. 2. She can no longer find her Form 137 after making earnest efforts to locate and search for it in her old school files. 3. As the Form 137 cannot be found or recovered, she is executing this Affidavit of Loss to attest that the form is lost and request its replacement from Nueva Ecija Dominican Academy.

Uploaded by

EarlLerio
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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REPUBLIC OF THE PHILIPPINES )

_________________________________ ) S.S.

AFFIDAVIT OF LOSS
I, VIANCA KAYE G. CRUZ, Filipino, of legal age, and resident of
__________________________________________, after being duly sworn to in accordance with law, do
hereby depose and state that:
1. I am a 2011 graduate of Nueva Ecija Dominican Academy who took up
__________________________________;
2. I am applying for an International Student Exchange and one of its requirements is
my Permanent School Record (Form 137)
3. However, I cannot anymore find such Form 137 from my old school files;
4. Earnest efforts were made in order to locate and search the said Form 137 ,however
it cannot anymore be found or its recovery is futile;
5. The said Form 137 was not used in any transaction ;
6. As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing
and request for the issuance of its replacement from Nueva Ecija Dominican
Academy.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________ at


_______________, Philippines.

VIANCA KAYE G. CRUZ


Affiant

SUBSCRIBED AND SWORN to before me this _______________ in the


_________________, affiant exhibiting to me:
Name ID No. Valid Until
VIANCA KAYE G. CRUZ _______________________ ____________________________

Doc No. ___;


Page No. ___;
Book No. ___;
Series of 2020.

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