Republic of the Philippines)

Province of Cagayan ) S.S.

City of Tuguegarao )

AFFIDAVIT OF LOSS

I, AGNES LIBERTY ARRIETA-FERNANDEZ, of legal age, married, Filipino and

a resident of San Basilio, Maxingal, Ilocos Sur, after having been duly sworn to in
accordance with law, do hereby depose and state:

That a PASSPORT was duly issued to me by the by the Department of

Foreign Affairs [DFA], San Fernando Branch, San Fernando, La Union, last October
2008;

That last month August, 2013, our place was flooded by typhoon Maring
and our things were destroyed and lost and, one of them was my PASSPORT;

That I exerted efforts to locate my passport, but the same proved futile;

That I believe that my passport is now beyond recovery;

That I am executing this Affidavit to attest to the truth of all the foregoing
statements and for the Department of Foreign Affairs of Tuguegarao City,
Cagayan to re issue another Passport in my name in lieu of the loss one.

Further affiant sayeth naught.

IN WITNESS WHEREOF, I have hereunto set my hand this 13th day of

September, 2013, at Tuguegarao City, Cagayan.

AGNES LIBERTY A. FERNANDEZ

Affiant

SUBSCRIBED AND SWORN to before me this 13th day of September, 2013

at Tuguegarao City, Cagayan.
Republic of the Philippines)
Province of Cagayan ) S.S.
City of Tuguegarao )

AFFIDAVIT OF LOSS

I, WILZON T. RIGOR, of legal age, married, Filipino and a resident of San Isidro, Diffun,
Quirino, after having been duly sworn to in accordance with law, do hereby depose and state:

That I am a Teacher by profession and as a Teacher I was issued a Teacher License by

the Professional Regulation Commission;

That sometime in the year 2004, while I was on way to our school, I noticed that my
wallet containing the said PRC License was lost and nowhere to be found;

That I exerted diligent efforts to locate my wallet containing the said PRC License but
the same proved futile;

That I am executing this Affidavit to attest to the truth of all the foregoing statement to
issue another PRC License in my name in lieu of the loss one.

IN WITNESS WHEREOF, I have hereunto set my hand this 30th day of May 2012, at
Tuguegarao City, Cagayan.

WILZON T. RIGOR
Affiant

SUBSCRIBED AND SWORN to before me this 30th day of May, 2012 at Tuguegarao City,
Cagayan, upon presentment of his PHILHEALTH Identification Card.

ATTY. ROBIN R. ARSITIO

Public Attorney II
PUBLIC ATTORNEY’S OFFICE
Department of Justice
Carig, Tuguegarao City, Cagayan
(PURSUANT TO R.A. 9406)