Republic of the Philippines)

DONE: CITY OF BAGUIO) SS.

AFFIDAVIT OF LOSS
I, MANNY B. NEBATEN, of legal age, married, Filipino Citizen, and resident of JC25
Km. 4, Pico, La Trinidad , Benguet, after having been duly sworn to in accordance with law do
hereby deposes and states, that:

1. I am a holder of a Professional Regulation Commission License Card for being a

Professional Teacher;

2. When I went to Cambodia to work, I brought along the aforesaid PRC License Card. I
just arrived in the Philippines for a vacation on July 9, 2023 and I took with me my
said license card for the purpose of having it be renewed;

3. This morning of this day, July 10, 2023, I prepared all the documents I need to work-
out/process while here in the Philippines, unfortunately, I could not locate the PRC
License Card which I kept in my wallet. I am not sure how I lost it, maybe it fell-off
in the car I took going home from Metro Manila to La Trinidad, Benguet on July 9,
2023, or it-fell off while I was in Metro Manila when I brought out my wallet;

4. Despite of my exerted diligent efforts, still I was not able to find my PRC License
Card, hence, considered beyond recovery;

5. The said PRC LICENSE CARD has not been given nor pledged to anyone for any
purpose whatsoever, nor was it taken nor confiscated by the authorities for any
violation of PRC rules and regulations;

6. I am executing this affidavit to attest to the truth of my foregoing statements and to

secure new PRC LICENSE CARD in lieu of the lost one, and for all legal intents
and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 10th day of July, 2023, at
Baguio City, Philippines.

MANNY B. NEBATEN
AFFIANT
Passport No. P6717740A
Valid Until: April 9, 2028

SUBSCRIBED AND SWORN TO before me this 10th day of July, 2023, at Baguio City,
Philippines. Affiant personally appeared and to be the same person who executed this instrument
as his free act and deed.

MODESTO T. ANDONG
Notary Public
Comm. N.A.-56-NC-22-R until Dec. 31, 2024
PTR No. 4902764/1-04-2023
IBP OR No. 271717/1-5-2023
ROLL No. 31289/5-15-81/Manila
Doc. No. ________; BIR TIN No. 121-017-652-000
Page No. ________ ANDONG and ASSOCIATE LAW OFFICE
Book No. 68; No. 19 2nd flr., Old Market Building,
Series of 2023. Upper Magsaysay Ave., Baguio City, 2600