REPUBLIC OF THE PHILIPPINES)

C I T Y O F GINGOOG ) S.S.
x--------------------------------------------x

AFFIDAVIT OF LOSS

I, _______________, of legal age, married, Filipino citizen, and a

resident of Purok 3, Brgy. 23, Gingoog City, Philippines, after having been
duly sworn to in accordance with law, do hereby depose and say that:

1. I am a holder of a PRC ID issued by the Professional Regulation

Commission.

2. On October 19, 2019, my family and I went to Medina Misamis

Oriental. I brought with me my bag which contained my wallet where
the said IDs were placed. At about 6pm on the said day, as we were
travelling back to Gingoog City, I discovered that my wallet which
contained the abovementioned IDs was missing;

3. I immediately called the management of Resort to report the incident

as the wallet could have been left or dropped at the resort but a week
after that incident my wallet was never returned.

4. I exerted diligent efforts to locate the said wallet but all efforts proved
futile as the same could no longer be found and considered the said
wallet together with the abovementioned IDs lost for all legal intents
and purposes;

5. As such, I am executing this Affidavit of Loss to attest to the truth of

the foregoing and to support my claim for the re-issuance of the new
PRC ID in lieu of the ones that were lost.

IN WITNESS WHEREOF, I have hereunto set my hand this 28 th day of

October 2019 in the City of Gingoog, Philippines.

__________________________
Affiant

SUBSCRIBED AND SWORN to before me this 28th day of October

2019 at Gingoog City, Philippines.

Doc. No. ____;

Page No.____;
Book No.____;
Series of 2019.