REPUBLIC OF THE PHILIPPINES }

CAGAYAN DE ORO CITY } S.S.

AFFIDAVIT

I, _______________________, of legal age, Filipino, single, and a resident of

____________________ after having been sworn to in accordance with law, hereby depose and
say that:

1. I was a student of _____________ from SY 2014-2015 until First Semester of SY

2016-2017;

2. When I transferred to __________________ in the Second Semester of SY 2016-

2017, I requested from the Registrar’s Office for the following documents: (a) Transcript of
Records; and (b) Honorable Dismissal;

3. Due to the academic demands, I was not able to get the above-mentioned
documents;

4. I understand that failure to claim the requested documents within six (6)
months after the date of request, the Registrar’s Office would dispose the same;

5. Thus, on February 2020, I requested for the second time for the issuance of
the aforementioned documents;

6. However, I was told that I need to submit an affidavit of loss to the said office
for the purpose of requesting again the above-mentioned documents;

7. Hence, I am executing this Affidavit to attest to the veracity of my statements

and for the issuance of the Registrar’s Office of the documents mentioned above.

IN WITNESS WHEREOF, I have hereunto affix my signature this _________________ at

Cagayan de Oro, Philippines.

Affiant

SUBSCRIBED AND SWORN to before me this ________________ in Cagayan de Oro City,

affiant exhibiting to me her _________________ issued by the __________________valid March 2029
as competent proof of identification.

Doc No.  _____                                                             

Page No. ______                                           
Book No. ______                                              
Series of 2020.