REPUBLIC OF THE PHILIPPINES)

Taguig City ) s.s.

AFFIDAVIT OF LOSS

I, Rhoalyn De La Rosa, of legal age, Filipino with residence at Rizal St.

Brgy Ezperanza Moral, South Cotabato after having been duly sworn to in
accordance with law hereby deposes and states:

1. That I am a holder of a PRC license as a Prof. Agricultural

Engineer issued to me by the Philippine Regulatory Commission;

2. That I put the aforementioned license inside my bag;

3. That suddenly when im about to use the ID as proof of identity for

sending money to my family with the Western Union, I cant find the
same inside my bag;

4. That I have exerted all diligent efforts to look for the said license
but my efforts proved futile and I considered it lost;

5. That I am executing this affidavit to attest to the veracity of all the

foregoing facts for the purpose of securing a replacement of the same and
for any legal purpose it may serve.

IN WITNESS WHEREOF I hereby sign this affidavit this __th day of April, 2015
at _________, Taguig City.

RHOALYN D. DE LA ROSA
Affiant

SUBSCRIBED AND SWORN to before me this __th day of April, 2015 at Taguig
City, affiant exhibiting to me his ID No._____issued by DOST-TAPI Taguig City
as proof of identity.

Notary Public

Doc No.____
Page No.___
Book No.____
Series of 2015