REPUBLIC OF THE PHILIPPINES

)
CITY OF ROXAS ) S.S
X---------------------------------------------X

AFFIDAVIT OF LOSS

I, CHRIS D. EGIDA, of legal age, single, Filipino, and a resident of
Block 4 Lot 12, Villa Alegria Subd., Punta Tabuc, Roxas City, Capiz after
having been duly sworn to in accordance with law, do hereby depose and
state;

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

2. That I kept the said PRC ID Card inside my drawer at home
together with my other important documents;

3. That recently, when I tried to look for the same in my drawer I could
not anymore find it;

4. I could not anymore ascertain where I placed or kept it and despite
diligent effort exerted to recover or locate the same I was not able to
find my PRC ID Card, such that I consider my PRC ID Card lost;

5. I am executing this affidavit to attest to the truth of the foregoing
facts and for Professional Regulation Commission to issue me a
new PRC ID Card in lieu of the lost one.

IN WITNESS WHEREOF, I have hereunto affixed my signature on this
______________ at ____________________.

CHRIS D. EGIDA
Affiant
PRC ID No. 0461131

SUBCRIBED AND SWORN to before me this ________________ at
___________________, affiant exhibiting to me his Competent Evidence of
Identity.

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