AFFIDAVIT OF LOST DIPLOMA

I, XXXXXXXXXXXXXXXXXXXXXXXXXXX, single, 29 years old and a resident of

zzzzzzzzzz, zzzzzzzzzzzzzz after being duly sworn in accordance with law, depose and
state that:
1. I was enrolled in the ladderized degree program in Accountancy of the
XXXXXXXXXXXXXXXXXXXfor the period June 2006 to March 2008.
2. Consequently, I graduated from the said university on March XXXXXX with the
Diploma in xxxxxxxxxxxxxxx and received the distinct honor of WITH
HONORS.
3. Subsequently, I again graduated from the said university on March
XXXXXXXXXX7 with a degree in xxxxxxxxxx and received the distinct honor of
CUM LAUDE.
4. I have received my diploma for each of the above-mentioned course programs
and kept them in my filing cabinet at home.
5. Tropical storm zzzzzz hit our place on zzzzzzzzzzz and badly affected our home.
6. Our personal belongings at home including my diplomas were washed away by
the flood. Hence, my diplomas were lost and could no longer be found/recovered
even with diligent efforts.
7. I am executing this affidavit for the purpose of requesting xxxxxxxxxxxxxxxxxx
to issue a second copy each for my diploma in Associate in Accounting
Technology and my diploma in xxxxxxxxx.
IN WITNESS WHEREOF, I have affixed my signature at Iligan Ctiy on May 14, 2015.
XXXXXXXXXXXXXXXXXX
Affiant

REPUBLIC OF THE PHILIPPINES) S.S

ILIGAN CITY
)
SUBSCRIBED AND SWORN to before me this ________day of ____________________,
20______ in __________________________, Philippines, affiant exhibiting to me her company
I.D. with ID no. 2009-043 issued by Mindanao State University Iligan Institute of
Technology on December 12, 2013.

Doc. No. _______

Page No._______
Book No._______
Series of _______