REPUBLIC OF THE PHILIPPINES )

PROVINCE OF TARLAC ) S.S.

MUNICIPALITY OF CAMILING )

AFFIDAVIT OF LOSS

I, MYLENE RAMOS DIMACULANGAN, 40 years old, single, Filipino

citizen and a resident of Barangay Cacamilingan Norte, Camiling, Tarlac,
Philippines, after having been duly sworn to in accordance with law, do hereby
depose and state THAT:

1. I finished my secondary education at the Camiling Catholic School,

Camiling, Tarlac in the year 1994 and I was issued by the said school a
Diploma upon graduation;

2. I kept the said diploma, together with other personal documents, in an

envelope and placed it in one of the cabinets in our house;

3. Lately, while I was organizing my school records/documents, I

discovered that my high school diploma was missing from the cabinet
where I was keeping it. Thus, I tried to locate the said diploma in the
other cabinets and drawers inside our house where the said diploma
might have been kept and/or transferred but I found nothing. I also
asked the members of my household if they have seen the same but all
answered in the negative;

4. All my diligent efforts to locate the said diploma turned futile; hence, I
now consider the same as lost and beyond recovery;

5. I am executing this affidavit to attest to the truth of the foregoing

statements and for all legal intents and purposes it may serve.

IN WITNESS WHEREOF, I hereunto affixed my signature this 15th day

of June, 2017 at Camiling, Tarlac, Philippines.

MYLENE R. DIMACULANGAN
Affiant

SUBSCRIBED AND SWORN to before me on the date and place

indicated above. Affiant exhibited to me her Philippine Passport EC1435106
issued by the Philippine Consulate General (PCG) Dubai, valid until June 18,
2019.

Doc. No. _____;

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