Republic of the Philippines ))

City of Calbayog )) s.s.

AFFIDAVIT OF LOSS
I, JONATHAN TIDO TERMO, Filipino, single, 23 years of age, and
presently residing at Barangay Macatingog, Calbayog City, Samar, Philippines,
after having been duly sworn to in accordance with law, hereby depose and
state, that--

1. Sometime in 2018, I finished my College Education at the Northwest

Samar State University (NWSSU) in Calbayog City and earned a
degree in BS Architectural Technology. And as such, I was issued a
College Diploma;

2. Last July 2019, the said College Diploma and other documents were
lost due to a fire at Brgy. Palanas, Calbayog City, where I stayed;

3. The said Diploma was not confiscated nor surrendered to any entities
especially by the said school;

4. I am executing this Affidavit to attest to the truth of the foregoing

facts and for whatever legal purpose this may serve;

IN WITNESS WHEREOF, I have hereunto set my hand this 7th day of

October 2019, at Calbayog City, Samar, Philippines.

JONATHAN TIDO TERMO

Affiant
PhilHealth ID: 13-050203993-9

SUBSCRIBED AND SWORN TO BEFORE ME, this 7th day of October

2019, at Calbayog City, Samar, Philippines.

ATTY. ALJUN B. DIAZ

Public Attorney I
Pursuant to RA 9406