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Republic of the Philippines )

Bontoc, Mt. Province )s.s.


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AFFIDAVIT OF LOSS

I, EVELYN A. QUIAO, of legal age, married, Filipino citizen and with residence and
postal address at Talubin, Bontoc, Mountain Province after having been duly sworn to in
accordance with law do hereby depose and say:

1. That I am a holder/owner of a the Professional Regulation Commission (PRC)


Identification Card bearing number 1618489 as a Professional Teacher;

2. That on August 28, 2018, I was checking my bag where I usually keep the said
PRC I.D. Card and I noticed for the first time that the same was missing;

3. That the same must have been misplaced as despite my diligent efforts and
inquiries to locate the said PRC I.D. Card, I was not able to find it up to the
present and therefore I consider the same as lost and beyond recovery;

4. That I undertake to surrender the said PRC I.D. Card in the event the same
could be found;

5. That I hereby hold the PROFESSIONAL REGULATION COMMISSION free and


harmless from any loss or damage that may be incurred by reason of or in
connection with the issuance of a new PRC I.D. Card;

6. That in view thereof, I am now requesting the Professional Regulation


Commission to issue another PRC I.D. Card in lieu of the lost one;

7. That I am executing this affidavit for the purpose of establishing the


foregoing facts and for all legal intents and purposes it may serve;

Affiant further sayeth naught.

IN WITNESS WHEREOF, I set my hand this 03rd day of September 2018 at Bontoc,
Mountain Province.

EVELYN A. QUIAO
Affiant
PRC ID Card No: 1618489

SUBSCRIBED AND SWORN to before me this 03 rd day of September 2018 at


Bontoc, Mountain Province affiant personally appeared before me, who is personally
known to me declaring that the contents of her Affidavit are true and correct and who
voluntarily affixed her signature above her name.

WITNESS MY HAND AND SEAL.

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