REPUBLIC OF THE PHILIPPINES )

PROVINCE OF NUEVA ECIJA )

IN THE CITY OF CABANATUAN ) S.S
x- - - - - - - - - - - - - - - - - - - - - - - - - - x

AFFIDAVIT OF LOSS

I, MA. DORIS-TETH BALINGIT MARCIAL, of legal age, Filipino Citizen,

married, and a resident of San Vicente, Cabiao, Nueva Ecija, after having been
duly sworn to in accordance with law do hereby depose and say:

1. That I am a holder/possessor of “Lupon para sa mga Propesyunal na

Guro“ issued by Professional Regulation Commission (PRC);

2. That I kept the said document inside my cabinet for safekeeping;

3. That when I made an inventory in all my important documents, I

discovered that the same was misplaced and/or lost without my
knowledge;

4. That in view of the above, the recovery of the same has become
impossible, hence, the need for this Affidavit of Loss;

5. That, I am executing this affidavit in order to prove the foregoing

facts and for all legal intents and purposes that this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 15th day of

October, 2018, hereat Cabanatuan City, Nueva Ecija.

MA. DORIS-TETH BALINGIT MARCIAL

Affiant

SUBSCRIBED AND SWORN to before me this 15th day of October, 2018, at

Cabanatuan City, Nueva Ecija. Affiant exhibiting to me her Competent Evidence
of Identity PRC Reg. No. 0997438; Registration Date: 12-18-2008; Valid Until 12-
14-2018.

Doc. No. 78;

Page No. 17;
Book No. II;
Series of 2018.