REPUBLIC OF THE PHILIPPINES )

City of Roxas ) S.S.

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AFFIDAVIT OF LOSS

I, ANTONETH G. HALANG, Filipino, of legal age, single and

a resident of Brgy. Pob. Takas, Cuartero, Capiz, after having
been duly sworn in accordance with law, hereby depose and
state:

1. That I am a holder of a PRC I.D bearing I.D No.

1697082 issued by Professional Regulation
Commission;

2. That the said PRC I.D and its whereabouts could not
be ascertained;

3. That diligent effort to locate and search in places

where I have been on that day, I lost it; However,
said PRC I.D was nowhere to be found;

4. That said PRC Identification Card was not confiscated

by the authorities by any reason. Neither I violated
any rules and regulations;

5. That I am executing this affidavit to attest to the

truth of the foregoing facts and to request for a
replacement of said PRC I.D.

IN WITNESS WHEREOF, I have hereunto set my hand

this 13th day of February, 2020 at the Roxas City, Philippines.

ANTONETH G.
HALANG
Teacher I.D No. 026

SUBSCRIBED AND SWORN to before me this 13th day

of February, 2020 in the City of Roxas, Philippines. I further
CERTIFY that I have personally examined the affiant, and I
am fully satisfied that he voluntarily executed the foregoing
Affidavit, and he read and understood the contents thereof.