Republic of the Philippines

Camiling, Tarlac

)
) S.S.

AFFIDAVIT OF LOSS
I, MARY GRACE A. MILLAN, 19 years old, Filipino citizen, single and a
resident of Barangay Surgui 2 nd, Camiling, Tarlac, after having been sworn to in
accordance with law do hereby depose and state THAT:
1. I was issued by the Technical Education Skills Development Authority
(TESDA) a TESDA Beauty Care NC II Certificate after completing the
required Beauty Care NC-II Program sometime in 2015 at the Tarlac
College of Agriculture (now Tarlac Agricultural University), Malacampa,
Camiling, Tarlac;
2. I kept the said document, together with my other personal documents,
placed in an envelope and kept in one of the cabinets in our house;
3. Recently, while I was organizing my personal effects, I discovered that the
envelope which contained the said NC II Certificate was missing;
4. I immediately searched the other possible drawers and cabinets in my
room where the said envelope/document might have been kept and/or
transferred but I found nothing. I also asked the members of my household
if ever they have seen the same but they all answered in the negative.
5. Diligent efforts exerted to locate the above-mentioned envelope containing
my TESDA Beauty Care NC II Certificate turned futile; hence, I now
consider the same as lost and beyond recovery;
6. I am executing this Affidavit to attest to the truth of the foregoing statement
and for all legal intents and purposes this may serve.
IN WITNESS WHEREOF, I have hereunto affixed my signature this 13 th day of
January, 2017 at Camiling, Tarlac, Philippines.
MARY GRACE A. MILLAN
Affiant
SUBSCRIBED AND SWORN to before me on the date and place indicated
above. Affiant exhibited before me her School ID with Student Number 2013101108
issued by the Tarlac College of Agriculture, Malacampa, Camiling, Tarlac.

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