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AFFIDAVIT of Loss - School Record

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Republic 

of the Philippines)
Province of Cebu )S.S.
Mandaue City )
x---------------x

AFFIDAVIT OF LOSS

I, JANET G. CUAMBOT, Filipino, of legal age, single and a resident of Banban,


Bogo City, Cebu, Philippines, after being duly sworn in accordance with law, depose
and state:

1. That I was a student of Southern Leyte State University, Sogod, Southern Leyte,
Philippines sometime on the year 2011;
2. That sometime on the year 2017, I requested my school records and I was issued;

3. However, the said school records while in my possession was misplaced and got
lost;

4. Efforts were exerted to locate the said school records however, it could not be
found and the same is now beyond recovery;

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


foregoing facts.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________ at


Mandaue City, Cebu, Philippines.

JANET G. CUAMBOT
Affiant

SUBSCRIBED AND SWORN TO before me ______________ in Mandaue City,


Cebu, Philippines, affiant being personally known to me to be the same person who
executed the foregoing instrument.

Doc. No. _____;


Page No. _____;
Book No. _____;
Series of 2021.

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