REPUBLIC OF THE PHILIPPINES)

Province of Southern Leyte) S.S.

City of Maasin )
x--------------------x

AFFIDAVIT OF LOSS

I, VANESSA VALERIE M. ROGADOR, Filipino, of legal age, married, and a

resident of Bgy. Tangkaan, Padre Burgos, Southern Leyte, after having been sworn in
accordance with law, do hereby depose and state:

1. That, I am a holder of a Professional Regulation Committee (PRC) ID issued by

PRC Office - Tacloban City;

2. That, I have placed the said PRC ID in my wallet but said wallet was lost
sometime October, 2015;

3. That, despite diligent search and efforts to locate the said PRC ID, I was not able
to find it such that I now believe that it is already lost beyond recovery; and

4. That, I am executing this Affidavit of Loss to attest to the truth of the foregoing
and to support for whatever legal purposes this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 5 th day of May 2017
at Maasin City, Southern Leyte, Philippines.

VANESSA VALERIE M. ROGADOR

Affiant
BIR TIN 445-708-563; 10-30-2015

SUBCRIBED AND SWORN to before me this 5 th day of May, 2017 at Maasin City,
Southern Leyte, Philippines affiant exhibiting to me valid and competent proof of identity
indicated below her name.