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Affidavit of Loss - Roldan S. Carlos

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REPUBLIC OF THE PHILIPPINES )

SAN NICOLAS, ILOCOS NORTE ) S.S

AFFIDAVIT OF LOSS

I, ROLDAN S. CARLOS, of legal age, Filipino citizen, and a resident of


Brgy. 11, San Fernando, San Nicolas, Ilocos Norte, Philippines, after having
been duly sworn to in accordance with law hereby depose and states that:

1. In the year 2000, I finished my secondary education at San Nicolas,


Ilocos Norte National High School (SNNHS) located at Brgy. 24, Santa
Monica, San Nicolas, Ilocos Norte;

2. Consequently, I was issued a Diploma by the said educational


institution as a proof that I completed my study thereat;

3. Vitally, commencing from the time of its issuance, I always safekept


said Diploma in my wooden cabinet situated in my bedroom;

4. Just recently, however, while I was organizing my personal things and


belongings inside my bedroom, I noticed that my said Diploma was
missing;

5. I immediately exerted diligent efforts to search for the whereabouts of


the said Diploma. Regrettably, all of my efforts turned futile. Hence, I
now consider the said Diploma lost and beyond recovery;

6. The said Diploma was neither confiscated nor seized for any violation
of law, rules and regulation;

7. I am executing this affidavit to request the authorities concerned to


issue me a new Diploma in lieu of the lost one; and

8. That I am executing this affidavit to attest to the veracity of my


statements and for whatever intents and purposes it may lawfully
serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 29 th day of


April 2024 at San Nicolas, Ilocos Norte, Philippines.

ROLDAN S. CARLOS
Affiant

SUBSCRIBED AND SWORN to before me this 29th day of April 2024 at


San Nicolas, Ilocos Norte, Philippines.

Doc. No. 484;


Book No. 98;
Page No. CCXXXIX;
Series of 2024.

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