Republic of the Philippines)

Province of Masbate ) S.S.

City of Masbate )

AFFIDAVIT OF LOSS
I, Cristina Kassandra M. Badillo., of legal age, Filipino and a resident of
Bajada, Cataingan, Masbate, after having been duly sworn to in accordance
with law, hereby depose and say:

1. That I am the owner of PRC License card issued by Professional Regulation

Commission ;

2. That recently, I noticed that PRC card was missing, efforts to locate in
vain, and for all intents and purposes considered lost or stolen;

3. That I wish to manifest that said card was not given or endorsed to
anybody but simply lost or stolen;

4. That I have executed this affidavit to attest to the truth of all the foregoing
and satisfy the inquiry or requirements of any person or office and for
other legal purpose.

IN WITNESS WHEREOF, I have hereunto set my hands this 9th day of March
2017 in the City of Masbate, Philippines.

__________________________

Affiant

JURAT

SUBSCRIBED AND SWORN to before me this 9th. Day of March 2017 at

Masbate City, affiant exhibited to me her TIN No. 424-340-285-000 issued on August
2, 2012.

Notary Public

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2017