Republic of the Philippines

Camiling, Tarlac
) S.S.

AFFIDAVIT OF LOSS
I, CRISLEE ANNE CANO y VALDEZ, 23 years old, Filipino citizen, single and a
resident of Mabini St., Poblacion D, Camiling, Tarlac, Philippines, after having been duly
sworn to in accordance with law do hereby depose and say THAT;
1. On March 25, 2016 in the afternoon, I took my wallet, rode on a passenger
tricycle and proceeded to the Camiling Public Market, Camiling, Tarlac to buy
some groceries;
2. My wallet contained my Professional Regulation Commission (PRC) License
card with registration number 0844778, some cash and other personal
belongings;
3. After paying the things I purchased, I went home. Upon reaching my
destination, I discovered that my wallet was missing. Immediately, I returned to
the Camiling Public Market and asked the owner of the store I earlier paid my
purchases if ever I left or dropped my wallet in the said establishment but he
answered in the negative. Also, I returned to the tricycle terminal and asked the
driver of the tricycle I boarded earlier if he had seen or found my wallet but he
answered in the negative;
4. I have waited for anybody to return my wallet or my PRC ID card but nothing
was returned up to this date;
5. All the diligent efforts exerted to locate my missing wallet which contained my
PRC ID card proved futile; hence, I now consider them as lost and beyond
recovery;
6. My PRC ID card was never pledged to secure any obligation;
7. I am executing this Affidavit to attest to the truth of the foregoing statements and
for all legal intents and purposes it may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this 12 th day of August,
2016 at Camiling, Tarlac, Philippines.
CRISLEE ANNE V. CANO
Affiant
SUBSCRIBED AND SWORN to before me on the date and place indicated above.
Affiant presented before me her ANSAP ID Card with Number 15-003758 issued by the
Association of Nursing Service Administrators of the Philippines, issued on 4/15/2015 and
valid until 4/15/2018.

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