AFFIDAVIT OF LOSS
I, MICHELLE BUNAO JERUSALEM, Filipino, of legal age, with residence at
Familia Village, Bagumbayan, Taguig City, after having been duly sworn in accordance
with law, do hereby depose and state that:
1. I am the owner of a High School Diploma from Cebu National Highschool;
2. Sometime in 2012, the said High School Diploma was misplaced and got lost;
3. Despite long and diligent efforts exerted, the said diploma could no longer be
found or recovered;
4. I am executing this Affidavit to attest the truth of the foregoing statements
and to support my request for a replacement copy of the above-mentioned
Diploma.
FURTHER AFFIANT SAYETH NAUGHT
IN WITNESS WHEREOF, I have hereunto affixed my signature this
__________________ in __________________________.
Michelle B. Jerusalem
SUBSCRIBED AND SWORN to before me this ___________________ in
Parañaque City, affiant exhibiting to me her State of Qatar ID. Card No. 28460818794
NOTARY PUBLIC
Doc No: _____
Page No: _____
Book No: _____
Series of 2017.