REPUBLIC OF THE PHILIPPINES )

Province of Leyte )
Municipality of Villaba ) S.S.
x--------------------------x

AFFIDAVIT OF LOSS
I, JUNWIL D. GERMAN, Filipino, of legal age, married, and a resident, of Brgy.
Hibulangan, Villaba, Leyte, Philippines, after being duly sworn to in accordance with law, hereby
depose and state:

1 That I am a graduate of Matag-ob National High School in 2003 and was issued a
DIPLOMA by the said school;

2 That sometime on November 2013, said Diploma which I placed inside our house got
damaged and lost because of Super Typhoon Yolanda that hit the province of Leyte;

3 That despite diligent search and efforts to locate and retrieve my Diploma, I could not
find the same such that I now believe that it is now lost beyond recovery;

4 As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing
and to support my application for the issuance of a new Diploma with the Matag-ob
National High School, in lieu of the one that was lost.

IN WITNESS WHEREOF, I have hereunto set my hand this 19th day of September 2018
at Villaba, Leyte, Philippines.

JUNWIL D. GERMAN
AFFIANT

SUBSCRIBED AND SWORN to before me, this 19th day of September 2018 at Villaba,
Leyte, Philippines, by the Affiant who is personally known to me (or whom I have identified through
competent evidence of identity) and who exhibited his Non-Professional Driver’s License ID No.
H12-18-000793 issued at LTO Palompon, Leyte, Philippines.

NOTARY PUBLIC

Doc. No. ___;

Page No. ____;
Book No. XIV;
Series of 2018.