Affidavit of Loss

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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;
[email protected]
Cellular Phone No. 09565207359

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