Republic of the Philippines )

Province of Pangasinan ) S.S.

______________________

AFFIDAVIT OF LOSS

I, RICHARD NOGUERA RAQUEL, of legal age, and residing at 009 Barangay Bangan Oda, Agno,
Pangasinan, after having been sworn according to law, hereby depose and state that:

1. I am a holder of a Professional Teacher Identification Card with License Number 1400761 issued by
Professional Regulation Commission (PRC).

2. On or about March 2020, I discovered the loss of the said PRC ID under the following circumstances:

3. Despite of diligent efforts, I could not find nor locate the same and I believe that it is truly lost

4. I am executing this affidavit for whatever legal purpose it may serve and to request for replacement or
duplicate of said PRC ID.

5. I attest to the truth of the foregoing information.

AFFIANT FURTHER SAYETH NAUGHT.

RICHARD NOGUERA RAQUEL

Affiant

SUBSCRIBED AND SWORN to before me this 28th day of July 2020 at ___________________ , affiant
personally appeared before me and exhibited to me Driver’s License No. A09-13-001013 and valid until
March 01, 2024.

Notary Public

Doc. No.______;
Page No.______;
Book No.______;
SERIES OF 2020