REPUBLIC OF THE PHILIPPINES )
In The City Of Davao )ss
x------------------------/
Affidavit Of Loss
I, JEFFREY FERNANDEZ ANTHONY, of legal age, Filipino,
married, a bona fide member of the Philippine National Police and a
resident of No. 634-7, Governor Sales Street, Brgy. 28-C, Davao
City, Philippines, after having been sworn to in accordance with law
do hereby depose and state:
1. That I am a holder of Philippine National Police ID (PNP
ID) issued by the Philippine National Police;
2. That on January 1, 2023, I discovered my PNP ID to be
missing from my bag;
3. That diligent efforts exerted to locate the lost PNP ID proved
to no avail, hence, this affidavit;
4. That I am executing this affidavit to attest to the truth of the
foregoing averments, purposely to submit the same to the
City Health Office to request for a replacement of my PNP
ID.
IN WITNESS HEREOF, I have hereunto affixed my signature
th
this 6 day of January, 2023 in the City of Davao, Philippines.
JEFFREY FERNANDEZ ANTHONY
Affiant
SUBSCRIBED AND SWORN to before me this 6TH day of
January, 2023 in the City of Davao, Philippines, and I HEREBY
CERTIFY that I have examined the affiant and that I am satisfied
that She voluntarily executed and understood the foregoing affidavit.
__________________________
REPUBLIC OF THE PHILIPPINES )
In The City Of Davao )ss
x------------------------/
Affidavit Of Loss
I, JEFFREY FERNANDEZ ANTHONY, of legal age, Filipino, married, a
resident of No. 634-7, Governor Sales Street, Brgy. 28-C, Davao City,
Philippines, after having been sworn to in accordance with law do hereby depose
and state:
1. That I am a holder of Philippine Passport issued by the
Department of Foreign Affairs, Davao City;
2. That at around 8:00 a.m. of January 1, 2023, upon arrival
home from Bankerohan, Brgy. 5-A, this city, I discovered the
loss of my said passport;
3. That diligent efforts exerted to locate my lost passport proved
to no avail, hence, this affidavit;
4. That the lost passport was not confiscated nor revoked in
violation of the laws of the Philippine Republic nor at any
foreign country for which the passport was used;
5. That I am executing this affidavit to attest to the truth of the
foregoing averments, purposely to submit the same to the
Department of Foreign Affairs in Davao City to request for a
replacement of my lost passport; and
6. That I undertake to surrender my passport should the same be
found in the future.
IN WITNESS HEREOF, I have hereunto affixed my signature
th
this 6 day of January, 2023 in the City of Davao, Philippines.
JEFFREY FERNANDEZ ANTHONY
Affiant
SUBSCRIBED AND SWORN to before me this 6TH day of January,
2023 in the City of Davao, Philippines, and I HEREBY CERTIFY that I
have examined the affiant and that I am satisfied that She voluntarily
executed and understood the foregoing affidavit.
__________________________
REPUBLIC OF THE PHILIPPINES )
In The City Of Davao )ss
x------------------------/
Affidavit Of Loss
I, JEFFREY FERNANDEZ ANTHONY, of legal age, Filipino, married, a
resident of No. 634-7, Governor Sales Street, Brgy. 28-C, Davao City,
Philippines, after having been sworn to in accordance with law do hereby depose
and state:
1. That I am a holder of PRC ID issued by the Professional
Regulation Commission, Davao City;
2. That at around 8:00 a.m. of January 1, 2023, upon arrival
home from Bankerohan, Brgy. 5-A, this city, I discovered the
loss of my said PRC ID;
3. That diligent efforts exerted to locate the lost PRC ID
proved to no avail, hence, this affidavit; and
4. That I am executing this affidavit to attest to the truth of
the foregoing averments, purposely to submit the same to
the Professional Regulation Commission to request for a
replacement of my PRC ID.
IN WITNESS HEREOF, I have hereunto affixed my signature
this 6th day of January, 2023 in the City of Davao, Philippines.
JEFFREY FERNANDEZ ANTHONY
Affiant
SUBSCRIBED AND SWORN to before me this 6TH day of January,
2023 in the City of Davao, Philippines, and I HEREBY CERTIFY that I
have examined the affiant and that I am satisfied that She voluntarily
executed and understood the foregoing affidavit.
__________________________
REPUBLIC OF THE PHILIPPINES )
In The City Of Davao )ss
x------------------------/
Affidavit Of Loss
I, JEFFREY FERNANDEZ ANTHONY, of legal age, Filipino, married, a
resident of No. 634-7, Governor Sales Street, Brgy. 28-C, Davao City,
Philippines, after having been sworn to in accordance with law do hereby depose
and state:
1. That I am a holder of Driver’s License issued by the Land
Transportation Office, Davao City;
2. That at around 8:00 a.m. of January 1, 2023, upon arrival home
from Bankerohan, Brgy. 5-A, this city, I discovered the loss of my
said Driver’s License;
3. That diligent efforts exerted to locate the lost Driver’s License
proved to no avail, hence, this affidavit; and
4. That I am executing this affidavit to attest to the truth of the
foregoing averments, purposely to submit the same to the City
Health Office to request for a replacement of my Driver’s
License.
IN WITNESS HEREOF, I have hereunto affixed my signature this 6th
day of January, 2023 in the City of Davao, Philippines.
JEFFREY FERNANDEZ ANTHONY
Affiant
SUBSCRIBED AND SWORN to before me this 6TH day of January,
2023 in the City of Davao, Philippines, and I HEREBY CERTIFY that I
have examined the affiant and that I am satisfied that She voluntarily
executed and understood the foregoing affidavit.
__________________________
REPUBLIC OF THE PHILIPPINES )
In The City Of Davao )ss
x------------------------/
Affidavit Of Loss
I, JEFFREY FERNANDEZ ANTHONY, of legal age, Filipino, married, a
resident of No. 634-7, Governor Sales Street, Brgy. 28-C, Davao City,
Philippines, after having been sworn to in accordance with law do hereby depose
and state:
1. That I am a holder of Taxpayers Identification Number
(TIN) No. 459-443-218;
2. That unfortunately, around 8:00 a.m. of January 1, 2023, upon
arrival home from Bankerohan, Brgy. 5-A, this city , I discovered
the loss of my wallet containing my Identification Cards,
including the said TIN;
3. That diligent efforts exerted to locate the lost TIN proved to
no avail;
4. That I am executing this affidavit to attest to the truth of the
foregoing averments, purposely to submit the same to the
Bureau of Internal Revenue (BIR), Davao City, to request
the replacement of my lost TIN.
IN WITNESS HEREOF, I have hereunto affixed my signature this 6th
day of January, 2023 in the City of Davao, Philippines.
JEFFREY FERNANDEZ ANTHONY
Affiant
SUBSCRIBED AND SWORN to before me this 6TH day of January,
2023 in the City of Davao, Philippines, and I HEREBY CERTIFY that I
have examined the affiant and that I am satisfied that She voluntarily
executed and understood the foregoing affidavit.
__________________________
REPUBLIC OF THE PHILIPPINES )
In The City Of Davao )ss
x------------------------/
Affidavit Of Loss
I, JEFFREY FERNANDEZ ANTHONY, of legal age, Filipino, married, a
resident of No. 634-7, Governor Sales Street, Brgy. 28-C, Davao City,
Philippines, after having been sworn to in accordance with law do hereby depose
and state:
1. I am a holder of a Philippine Health Insurance Corpporation
Card (PhilHealth Card) No. 160000788268;
2. Unfortunately, around 8:00 a.m. of January 1, 2023, upon
arrival home from Bankerohan, Brgy. 5-A, this city, my wallet
containing my personal documents, including my
PhilHealth Card was lost;
3. Despite, diligent efforts exerted to locate, my wallet as well
as my PhilHealth Card could not be found, hence this
affiavit;
4. I am executing this affidavit to attest to the truth of the
foregoing averments and to submit the same to the
Philiippine Health Insurance Corporation (PhilHealth) Davao
City, purposely to request for a replacement of my lost
PhilHealth Card.
IN WITNESS HEREOF, I have hereunto affixed my signature this 6th
day of January, 2023 in the City of Davao, Philippines.
JEFFREY FERNANDEZ ANTHONY
Affiant
SUBSCRIBED AND SWORN to before me this 6TH day of January,
2023 in the City of Davao, Philippines, and I HEREBY CERTIFY that I
have examined the affiant and that I am satisfied that She voluntarily
executed and understood the foregoing affidavit.
__________________________
REPUBLIC OF THE PHILIPPINES )
In The City Of Davao )ss
x------------------------/
Affidavit Of Loss
I, JEFFREY FERNANDEZ ANTHONY, of legal age, Filipino, married, a
resident of No. 634-7, Governor Sales Street, Brgy. 28-C, Davao City,
Philippines, after having been sworn to in accordance with law do hereby depose
and state:
1. That I am a holder of an Union Bank Automatic Teller
Machine Card (ATM Card);
2. That unfortunately, around 8:00 a.m. of January 1, 2023, upon
arrival home from Bankerohan, Brgy. 5-A, this city, I
discovered the loss of my ATM Card;
3. That diligent efforts exerted to locate the my lost Card
proved to no avail;
4. That the lost ATM Card was not encumbered in any
manner;
5. That I am executing this affidavit to attest to the truth of the
foregoing averments, purposely to submit the same to
Union Bank, purposely to request for a replacement of my
lost ATM Card.
IN WITNESS HEREOF, I have hereunto affixed my signature this 6th
day of January, 2023 in the City of Davao, Philippines.
JEFFREY FERNANDEZ ANTHONY
Affiant
SUBSCRIBED AND SWORN to before me this 6TH day of January,
2023 in the City of Davao, Philippines, and I HEREBY CERTIFY that I
have examined the affiant and that I am satisfied that She voluntarily
executed and understood the foregoing affidavit.
__________________________
REPUBLIC OF THE PHILIPPINES )
In The City Of Davao )ss
x------------------------/
Affidavit Of Loss
I, JEFFREY FERNANDEZ ANTHONY, of legal age, Filipino, married, a
resident of No. 634-7, Governor Sales Street, Brgy. 28-C, Davao City,
Philippines, after having been sworn to in accordance with law do hereby depose
and state:
1. That I am a holder of a Vaccination Card issued by the City
Health Office of Davao;
2. That at around 8:00 a.m. of January 1, 2023, upon arrival home
from Bankerohan, Brgy. 5-A, this city, I discovered the loss of
my said Vaccination Card;
3. That diligent efforts exerted to locate the lost Vaccination
Card proved to no avail, hence, this affidavit; and
4. That I am executing this affidavit to attest to the truth of the
foregoing averments, purposely to submit the same to the
City Health Office to request for a replacement of my
Vaccination Card.
IN WITNESS HEREOF, I have hereunto affixed my signature this 6th
day of January, 2023 in the City of Davao, Philippines.
JEFFREY FERNANDEZ ANTHONY
Affiant
SUBSCRIBED AND SWORN to before me this 6TH day of January,
2023 in the City of Davao, Philippines, and I HEREBY CERTIFY that I
have examined the affiant and that I am satisfied that She voluntarily
executed and understood the foregoing affidavit.
__________________________
REPUBLIC OF THE PHILIPPINES )
In The City Of Davao )ss
x------------------------/
Affidavit Of Loss
I, JEFFREY FERNANDEZ ANTHONY, of legal age, Filipino, married, a
resident of No. 634-7, Governor Sales Street, Brgy. 28-C, Davao City,
Philippines, after having been sworn to in accordance with law do hereby depose
and state:
1. That my child, CANDICE JIREH DAGOOK ANTHONY, was a
holder of a Vaccination Card issued by the City Health Office
of Davao;
2. That at around 8:00 a.m. of January 1, 2023, upon arrival home
from Bankerohan, Brgy. 5-A, this city, I discovered the loss of
my child’s said Vaccination Card;
3. That diligent efforts exerted to locate the lost Vaccination
Card proved to no avail, hence, this affidavit; and
4. That I am executing this affidavit to attest to the truth of the
foregoing averments, purposely to submit the same to the
City Health Office to request for a replacement of my
Vaccination Card.
IN WITNESS HEREOF, I have hereunto affixed my signature this 6th
day of January, 2023 in the City of Davao, Philippines.
JEFFREY FERNANDEZ ANTHONY
Affiant
SUBSCRIBED AND SWORN to before me this 6TH day of January,
2023 in the City of Davao, Philippines, and I HEREBY CERTIFY that I
have examined the affiant and that I am satisfied that She voluntarily
executed and understood the foregoing affidavit.
__________________________
