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Loss PRC ID

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Republic of the Philippines )

___________________ ) S.S.

AFFIDAVIT OF LOSS

I, MARCO PAULO CAYMO NABONG, of legal age, Filipino and a


resident of #9 Asecencion Hills, Angono, Rizal, after being duly sworn to in
accordance with law, hereby depose and state :

1. That I am a holder of PRC identification card bearing License Card No.


131172 issued by the Professional Regulation Commission (PRC) ;

2. That by the nature of the said document, I kept the same inside my
wallet, which wallet I then usually placed in the back pocket of my pants;

3. That on ________________, I discovered that said PRC License


Card was missing from my wallet;

4. That diligent efforts exerted to locate the same proved futile as I could
no longer tell how and where my wallet was lost;

5. That I therefore execute this affidavit to declare the fact of loss of


my PRC License Card issued by Professional Regulation Commission
(PRC) for the purpose of inducing the concerned office to issue me the
same in lieu of the loss one;

6. That I attest to the truthfulness and veracity of the foregoing


statements having been made of my own personal knowledge and
belief and for whatever legal purpose it may serve.

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


October, 2019 at the ___________________.

_____________________________
MARCO PAULO CAYMO NABONG
Affiant

SUBSCRIBED AND SWORN TO before me this ____ day of October, 2019 at


_____________________, affiant having exhibited to me his Identification
Card _____________________.

Doc. No._____;
Page No._____;
Book No._____;
Series of 2 0 1 9.

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