Republic of the Philippines)

Province of Surigao del Sur

CITY

OF

TANDAG

) SS.

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

AFFIDAVIT OF LOSS
I, ELLEN L. BALAN, of legal age, single, residing at Purok 3, Poblacion,
Cortes, Surigao del Sur after being sworn in accordance with law depose and
say that:
1. That I am an alumna of Saint Theresa College - College Department;
2. That I obtain the degree of Bachelor of Science in Accountancy last
1997;
3. That as such, I was issued by the School Registrar a copy of my
COLLEGE DIPLOMA;
4. That for safety purposes I placed it in a folder/envelop together with
other pertinent documents;
5. However, the said folder/envelop was misplaced and nowhere to be
found and despite diligent effort to locate and retrieve my COLLEGE DIPLOMA
the same proved futile;
6. That I am executing this affidavit to request the School Registrar of
Saint Theresa College to reissue another COLLEGE DIPLOMA in lieu of the lost
one;
8. That this Affidavit is executed to attest the truth and veracity of the
foregoing statement and for whatever legal purposes this may serve best.
In WITNESS WHEREOF, I have hereunto set my hand this 18 th day of
October 2016, in the City of Tandag, Surigao del Sur, Philippines.

ELLEN L. BALAN
Affiant
SUBSCRIBED AND SWORN TO before me this 18th day of October 2016
at Tandag City, Surigao del Sur, Philippines. I HEREBY CERTIFY that I have
personally examined the affiant who appears to me personally and personally

ATTY. JOSE P. ZAFRA IV, R.M.T.

known to me and I am fully satisfied that she executed and understood her
Notary Public

sworn statement.

for Tandag City, Surigao del Sur

Until December 2017
ZAFRA LAW OFFICES
Contact nos. (086)211-3216/09224309694
086 Osmea St., Purok Maganda

Barangay Bag-ong Lungsod,

Tandag City, Surigao del Sur 8300

Attorney Roll No. 62822-5/6-2014

IBP no. 968854/4-11-2014/Pasig City
PTR no. 5138663/5-19-2014/Tandag City

Doc No. 210

Page No. 046
Book No. IV
Series of 2016