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Republic of the Philippines)

Tarlac City )S.S

AFFIDAVIT OF LOSS

I, DIANNE REYES ANGARA, of legal age, Filipino citizen, and


resident and with postal address at #017 Laungcupang, Lapaz, Tarlac, do
hereby depose and say:

1. That I am a graduate of Central Luzon Doctor’s Hospital


Educational Institution, San Pablo, Tarlac City in 2010;

2. That I was issued a Original by said School;

3. That said Diploma was missing and must have been lost
sometimes in March 2008, despite long and diligent it could no
longer be recovered.

4. I am executing this Affidavit to attest to the truth of the foregoing


and to support a request for replacement copy of the above-
mentioned Diploma.

AFFIANT FURTHER SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto affixed my signature


this ______________ in the City of Tarlac, Philippines.

JULIE P. FREJAS
Affiant

SUBSCRIBED AND SWORN to before me this _______________ in


the City of Tarlac, Philippines.

Doc. No. _____;


Page No. _____;
Book No. _____;
Series of 2018.