AFFIDAVIT OF LOSS

DIPLOMA

Republic of the Philippines)

Quezon City ) S.S.

x-------------x

I, ANDREA BRONCANO LIVELO, of legal age, Filipino, single, and a

resident of 26 Florentino St., Brgy. Sto. Domingo, Quezon City, Philippines, after
having been duly sworn in accordance with law, hereby depose and state that:

1. On March 2017, I completed Junior High School and graduated from Sienna
College of Quezon City.

2. Consequently, as proof of the said completion, I was issued a Junior High

School Diploma (“Diploma”) by the said school;

3. Recently I had tried to look for the said Diploma but the same could not be
found;

4. I believe that the said Diploma was lost when our house was flooded during
the height of a storm sometime in September 2017.

5. Despite diligent search and efforts to locate the said Diploma, I could not find
the same such that I now believe that it is now lost beyond recovery;

6. As such, I am executing this Affidavit of Loss to attest to the truth of the

foregoing and to support any and all of my college applications.

IN WITNESS WHEREOF, I have hereunto set my hand this 13 July 2018 at

Quezon City, Philippines.

ANDREA BRONCANO LIVELO

AFFIANT

SUBSCRIBED AND SWORN TO BEFORE ME this 13 th day of July 2018 in

Quezon City, Philippines, affiant having exhibited to me her Passport with number
P7388710A which expires on May 30, 2028.

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