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 13 th 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.