Republic of the Philippines)

DONE: CITY OF BAGUIO…..) S.S.

AFFIDAVIT OF LOSS
I, MELISSA FELIPE CALSI, of legal age, single, Filipino Citizen with
residence and postal address at Dengsi, Tawang, La Trinidad, Benguet, after
having been duly sworn to in accordance with law do hereby depose and state
that:

1. I have completed my SECONDARY HIGH SCHOOL at BENGUET

NATIONAL HIGH SCHOOL - MAIN at Stockfarm, Wangal, La
Trinidad, Benguet and was Issued a DIPLOMA;

2. However, the aforementioned DIPLOMA was lost. I have misplaced it

in our house due to the fact that I kept it for a long time, So I cannot
anymore recall where I placed it;

3. I exerted diligent efforts to locate the said DIPLOMA but the same
could no longer be found;

4. The said DIPLOMA has not been given nor pledged to anyone for any
purpose whatsoever, nor was it taken or confiscated by the authorities
for any violation of any law;

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

statements and for purposes of securing a NEW COPY of my
DIPLOMA in lieu of the lost one and for all legal intents and purposes
it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 14th day of

February, 2018 at Baguio City, Philippines.

MELISSA FELIPE CALSI

Affiant
PRC Reg. No.: 0691632
Valid Until: 12-21-2020

SUBSCRIBED AND SWORN TO before me this 14th day of February,

2018 at Baguio City, Philippines, affiant exhibiting to me her PRC ID indicated
below her name and signature.

MODESTO T. ANDONG
Notary Public
Comm. No. 39-NC-18-R/Until: December 31, 2019
PTR No. 3397734/12-13-2017/BC
IBP No. 1083758/12-13-2017
Baguio-Benguet Chapter
Roll No. 31289/5-15-81/Manila
Doc. No. 281; MCLE COMPLIANCE No. VI-0000192/June 14, 2016
Page No. 58; BIR TIN No. 121-017-652
Book No. XXVIII; No. 19, 2nd Floor Old Market Bldg.,
Series of 2018. Magsaysay Ave., Baguio City, Philippines

AFFIDAVIT OF LOSS
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