Republic of the Philippines ]

City of Tagbilaran ] S.S.

AFFIDAVIT OF LOSS

I, ICHIE JEFFERSON A. QUIBEL, Filipino, of legal age, married and a resident of

Poblacion Maribojoc, Bohol, Philippines, after being duly sworn in accordance with law, hereby
depose and say:

1. That I was issued by PMI COLLEGES BOHOL, Tagbilaran City, Bohol, of a College
Diploma for a degree in Bachelor of Science in Marine Transportation as of
November 5, 2001 with S.O. No. 50-897201-0107 s. 2002 dated March 7, 2002, at
PMI Colleges-Bohol Campus, City of Tagbilaran;

2. That said College Diploma was misplaced last December 2019;

3. That I exerted diligent efforts to find and recover the aforesaid College Diploma,
however, my efforts proved futile as until now, its whereabouts still could not be
ascertained, hence, I considered it to be lost for all intents and purposes;

4. That the said College Diploma was not transferred to any person for consideration or
used as collateral to secure obligations;

5. That I execute this affidavit voluntarily to attest to the truth of the foregoing
statements to support my request for the issuance of another College Diploma in lieu
of the lost one;

6. That further, I execute this affidavit for whatever legal purpose this may serve.

IN WITNESS WHEREOF, I hereunto set my hand this 10th day of September, 2020 at
Tagbilaran City, Bohol, Philippines.

ICHIE JEFFERSON A. QUIBEL

Affiant
Driver’s License ID No. G03-98-044679
Land Transportation Office

SUBSCRIBED AND SWORN TO before me this 10th day of September, 2020 at

Tagbilaran City, Bohol, Philippines.

ATTY. RALP RYAN A. LAGURA, CPA

MAULAS & LAGURA Law Offices
G/F Castelcelo Building 2 Gallares St,
corner J.S. Torralba St, Tagbilaran City
NOTARY PUBLIC until December 31, 2020
NCS No. 2019-68; TIN 263-686-047-000
Roll No. 72594, June 17, 2019
IBP Membership No. 088674; June 7, 2019
PTR No. 7958107; CY 2020
For the City of Tagbilaran and Other Municipalities of Bohol