Republic of the Philippines)

City/Province of ___________)s.s.

AFFIDAVIT OF LOSS

I, MA. LUISA VILLANUEVA ALFARO, of legal age, Filipino and with

residence address at Brgy. Tabun-acan, Pilar, Capiz, after having duly sworn to in
accordance with the law hereby depose and state THAT:

1. I am a registered Pharmacist and was issued with a Professional

Identification Card by the Professional Regulation Commission with the following
details:

Registration No. 0051425

Registration Date 04/01/2005
Valid Until 9/17/2020.

Photocopy of said PRC ID is hereto attached as Annex “A”

2. I intend to renew aforementioned Identification Card, unfortunately I can

no longer present the original since it was lost during the devastation of Typhoon Ursula.

3. Our house in President Roxas, Capiz, where said Identification Card was
kept including other documents, was inundated and all our belongings were washed
away.

4. Said Identification card could no longer be found inspite of earnest effort

to locate the same.

5. I am executing this affidavit to attest to the truth of the foregoing facts and
to support the renewal of my PRC Identification Card/ License.

IN WITNESS WHEREOF, I have hereunto set my hand this 21st day of

September 2020 at Roxas City, Capiz.

MA. LUISA V. ALFARO

Affiant

SUBSCRIBED AND SWORN TO before me this _____ day of ___________, 2020 at

___________________, Philippines. Affiant exhibited to me a competent evidence of her identity
consisting of __________________________.

NOTARY PUBLIC
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2020.