REPUBLIC OF THE PHILIPPINES)

C I T Y O F D A V A O ) SS.
x- - - - - - - - - - - - - - - - - --x

AFFIDAVIT OF LOSS

I, DANIELLE G. DIAZ, married, of legal age, Filipino, and a resident of

Davao City, Philippines, after being duly sworn in accordance with law hereby
depose and say that:

1. I am the holder of a Diploma from University of the Philippines

Mindanao.

2. The abovesaid Diploma was in my possession from the time of their

issue until sometime on May 20, 2018, when I noticed that the
abovesaid Diploma was no longer along my personal documents in my
house.

3. Notwithstanding diligent efforts exerted to locate them, the same were

not found nor recovered hence considered lost for all intents and
purposes.

4. I attest to the truth of the foregoing circumstances and that I am

executing this affidavit to apprise any and all persons of such fact of
loss and for whatever other legal purposes this affidavit may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

_______________ at Davao City, Philippines.

DANIELLE G. DIAZ
Affiant
UMID No. 0111-5089373-9

SUBSCRIBED and sworn to before me, in the City of Davao, this

______________, affiant exhibiting to me his competent evidence of identity
first written above below his name.
Doc. No. ____
Page No. ____
Book No. ____
Series of 2018.