REPUBLIC OF THE PHILIPPINES

CITY OF PASIG

AFFIDAVIT OF LOSS

I, Tony Mar A. Gragas, Filipino, of legal age and a resident of 43C Elisco Road, Kalawaan, Pasig City, after
having duly sworn to in accordance with the law, hereby depose and say that:

1. I am a holder of a Registered Electrical Engineer Identification Card issued by Professional

Regulation Commission;

2. I lost my identification card on January 5, 2020, and that I exerted all my efforts to locate the same
but I could not remember exactly where I placed it and it is considered lost for legal purposes;

3. Said identification card was not confiscated by any officer of the law by reason of any violation of
any law, ordinance, presidential decree or rules and regulation of the said Commission; and
neither was it offered as collateral for any loan;

I am executing this affidavit to attest to the foregoing facts;

IN WITNESS WHEREOF, I have hereunto set my hand this 20th of March 2020 in the City of Pasig,
Philippines.

TONY MAR A. GRAGAS

Affiant

SUBSCRIBED AND SWORN to before me this __________________ in the City of __________________,

Philippines, affiant having exhibited to me his/her community tax certificate with no. _________________
issued on _________________ at ___________________.

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