REPUBLIC OF THE PHILIPPINES)

CITY OF ILOILO ) S.S.

x--------------------------------------------------x

AFFIDAVIT OF LOSS

I, MEGAN MARIE R. SUBONG, of legal age, Filipino, and a

resident of 20 St., Westwood Subdivision, Dungon C, Mandurriao, Iloilo
City, Philippines after having been duly sworn to in accordance with law
hereby voluntarily depose and say that:

1. I am a holder of a CERTIFICATE OF REGISTRATION (BOARD

CERTIFICATE) issued by the PROFESSIONAL REGULATION
COMMISSION last July 25, 2016;
2. The same certificate declares that I have obtained and passed the
qualifications to become a registered Radiologic Technologist;
3. However, sometime last month, I discovered that the said Board
Certificate is no longer in the place where I usually keep the same;
4. Despite my diligent search and efforts, I cannot find the said Board
Certificate;
5. Henceforth, I consider it as lost and beyond recovery;
6. I am executing this affidavit to the truthfulness of the foregoing. This
Affidavit attests for the purpose of obtaining another copy of the said
Certificate of Registration or Board Certificate before the Professional
Regulation Commission and for any legal purpose(s) it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this

_______________ in the City of Iloilo, Philippines.

MEGAN MARIE R. SUBONG

Affiant
PRC I.D. No. 0015669

JURAT

The affiant, whose name and personal circumstances are stated

above, personally appeared before me this ____________ in the City of
Iloilo, Philippines, presented the foregoing affidavit, signed the same in
my presence and affirmed under oath to the correctness of the contents or
allegations of the same.
The affiant was identified by competent evidence of identity
appearing below his name.

Doc. No. ___;

Page No. ___;
Book No. ____;
Series of 2021.