Republic of the Philippines )

Zamboanga City . . . ) S.S.

AFFIDAVIT OF LOSS
I, WINSTON JAMES AZUCENAS ACIERTO, of legal age, Filipino
citizen, single and a resident of Kalantas Street, Zambowood,
Zamboanga City, Philippines, after having been duly sworn to
in accordance with law, do hereby depose and state THAT:
1. I am a member of the Philippine Health Insurance
Corporation (PhilHealth) and I was issued an
identification card which I usually keep inside my
wallet;

2. Lately, when I was organizing the contents of my wallet,

I discovered that my PhilHealth ID card was missing. I
tried to look for it in my other wallets but I did not
find the same. Also, I asked my household members if they
have seen it but all answered in the negative;

3. All the diligent efforts exerted to locate my PhilHealth

ID proved futile; hence, I now consider the same as lost
and beyond recovery;

4. My PhilHealth ID Card was never used as a security to any

obligation;

5. 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 hereunto affixed my signature this

______________________at Zamboanga City, Philippines.

WINSTON JAMES AZUCENAS ACIERTO

Affiant

SUBSCRIBED TO AND SWORN to before me on the date and

place indicated above. Affiant exhibited to me his Postal ID
Card bearing No. N10160580226P Zmbga. City

Doc. No.:________;
Page NO.:________;
Book No.:________;
Series of 2020.