Republic of the Philippines)

City of San Fernando, Pampanga) S.S.

AFFIDAVIT OF LOSS

I, Jim Kirby P. Cunanan, married, Filipino, and a resident of St. Francis Village, Brgy. Dolores, City
of San Fernando, Pampanga, after being sworn in accordance with the law depose and say that:
1. I lost the following Identification Cards (IDs) last November 18, 2021:
 Professional Identification Card (with Registration No. 0142756) issued by the
Professional Regulation Commission (PRC) and valid until April 6, 2024; and
 Driver’s License (with License No. C10-08-006959) issued by the Land
Transportation Office and valid until April 6, 2023.
2. Despite diligent efforts to find the said IDs, the same could no longer be found and proved to
be beyond recovery;
3. This affidavit is being executed to attest to the truth of the foregoing facts, for purposes of
re-issuance of a new PRC ID and a Driver’s License, and for whatever legal purposes it may
serve under the law; and
4. In support of my application for re-issuance of a new PRC ID and Driver’s License, I attached
herein copies of my old PRC ID and Driver’s License. Please see Annex A for the copies of the
said IDs.

IN WITNESS HEREOF, I hereunto set my hands and affix my signature this ________________ 2021
in the City of San Fernando, Pampanga.

Jim Kirby P. Cunanan

Affiant

SUBSCRIBED AND SWORN to before me this ______ day of ___________________ 2021 at City of
_________________________, affiant personally appeared before me and exhibited to me her
_________________________ with the following details: _________________________ issued at
_________________________ and valid until ___________________________.

Doc No. _____;

Page No. ____;
Book No. ____;
Series of 2021.
Annex A