REPUBLIC OF THE PHILIPPINES ) Bangui, Ilocos Norte) SS.

AFFIDAVIT OF LOSS

I, CLINIA F. RAMISCAL, Filipino, of legal age, single, and a resident of Dumalneg, Ilocos Norte, after having been duly sworn in accordance with law, hereby depose and say: 1. That I was issued a diploma by the Bangui National High School (Lanao Campus) in which I graduated last April 2005; 2. That after they handed me the said diploma, I kept the same in the cabinet in our house and that after my graduation in college, I went to Manila to have my review and took the Licensure Exam for Physical Therapist. 3. That sometime this year, when I arrived home from a job interview in which I was able to passed, and they required me to submit a diploma, it is the only time that I discovered that my high school diploma was no longer in our cabinet where I placed it; 4. Despite diligent search and efforts to locate said document, I could not find it. 5. That said diploma was not confiscated by the authorities of Bangui National High School (Lanao Campus) by reason of any violation of the said school rules and regulations; 6. That I am executing this affidavit to attest to the truth of the foregoing facts and to request for a replacement of said diploma from Bangui National High School (Lanao Campus).

IN WITNESS WHEREOF, I have hereunto affixed my signature this ____day of ____________ 20___ at ____________, Philippines.

____________________ CLINIA F. RAMISCAL SUBSCRIBED AND SWORN TO before me, a notary public in and for _____________________ this ____ day of ____________ 20___. The affiant, whom I identified through the following competent evidence of identity; personally signed the foregoing instrument before me and avowed under penalty of law to the whole truth of the contents of said instrument. Notary Public Doc. No. ..; Page No. .; Book No. .; Series of 2012.