Republic of the Philippines)

DONE: CITY OF BAGUIO..) S.S.

AFFIDAVIT OF LOSS
I, AUBREY FONTANILLA ZARATE, of legal age, single, Filipino Citizen
with residence and postal address at East Quirino Hill, Baguio City, after
having been duly sworn to in accordance with law do hereby depose and state
that:

1. I am an owner of a PROFESSIONAL REGULATORY COMMISION

IDENTIFICATION CARD (PRC ID) issued by the Professional
Regulatory Commission (PRC) for being a Nurse;

2. Last January 2017 at Tarlac City, I tried to withdrew on an ATM but

to my shock I notice that my wallet containing my PRD ID and other
items was stolen or have fallen from my pocket, I might have lost it on
the Public Market before I went to said ATM;

3. I exerted diligent efforts to locate the said PRC ID but the same could
no longer be found;

4. The said PRC ID has not been given nor pledged to anyone for any
purpose whatsoever, nor was it taken or confiscated by the authorities
for any violation of any law;

5. I am executing this affidavit to attest to the truth of my foregoing

statements and for purposes of securing new PRC ID 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 15th day of

February 2017, at Baguio City, Philippines.

AUBREY FONTANILLA ZARATE

Affiant
Phil. Pass. No.: P0477773A
Issued at DFA BAGUIO
Valid Until: 30 Sep 2021

SUBSCRIBED AND SWORN TO before me this 15th day of February

2017, at Baguio City, Philippines, affiant exhibiting to me her Philippine
Passport indicated below her name and signature.

MODESTO T. ANDONG
Notary Public
Commission No. 35-NC-16-R/Until: December 31, 2017
PTR No. 2945281/01-05-2017/Baguio City
IBP No. 1056844/01-05-2017/Baguio-Benguet Chapter
Roll No. 31289/5-15-81/Manila
Doc. No. 080; MCLE COMPLIANCE No. VI-0000192/June 14, 2016
Page No. 16; BIR TIN No. 121-017-652
Book No. XXI; No. 19, 2nd Floor Old Market Bldg.,
Series of 2017. Magsaysay Ave., Baguio City, Philippines

Affidavit of Loss
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