Republic of the Philippines )

Province of Southern Leyte ) s.s.

Municipality of Tomas Oppus )
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AFFIDAVIT OF LOSS

I, GALBRAITH M. DEJITO, of legal age, single, Filipino and a resident of

Sogod, Southern Leyte after having been duly sworn to in accordance with law,
hereby depose and say:

1. That I am a student of Southern Leyte State University, College of Teacher

Education, San Isidro, Tomas Oppus, Southern Leyte and such I was issued
a school clearance at the end of the semester;

2. That sometime on January 2019, the aforementioned School Clearance

got lost and nowhere to be found;

3. That exhaustive efforts were exerted to locate the same but my search
proved futile as I could not locate the same up to present;

4. That I executed this affidavit in order to attest to the truth and veracity of
the foregoing and for whatever legal intents and purposes this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 19th day of February
2019 in the Municipality of Tomas Oppus, Southern Leyte, Philippines.

GALBRAITH M. DEJITO
Affiant
SLSU ID NO. 16-10140

SUBSCRIBED AND SWORN to before me this 14th day of February 2019 in

the Municipality of Tomas Oppus, Southern Leyte, Philippines.