REPUBLIC OF THE PHILIPPINES)

PROVINCE OF SURIGAO DEL SUR) s.s.

MUNICIPALITY OF TAGO)

AFFIDAVIT OF LOSS
(Honorable Dismissal)

I, JOHN PAUL T. FALCON, Filipino, 22 years old, single, and a

resident of Purok Over The Rainbow, Bag-ong Lungsod, Tandag City,
Surigao del Sur, Philippines, after having been duly sworn to in
accordance with law, depose and state:

1. That I was issued by the Surigao del Sur State University,

Tandag City, an Honorable Dismissal on April 23, 2012;

2. That said Honorable Dismissal was unfortunately lost and

its whereabouts cannot anymore be ascertained despite my
diligent search; and

3. That I am executing this Affidavit of Loss to attest to the

veracity of the foregoing and for whatever legal purpose
this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature

this 7 day of March, 2017 at Tago, Surigao del Sur, Philippines.
th

JOHN PAUL T. FALCON

AFFIANT

SUBSCRIBED AND SWORN TO before me this 7th day of

March, 2017 at Tago, Surigao del Sur, Philippines. The identity of the
affiant is established by his Student ID with No. 2011-00772.