Affidavit of Loss - Governmnet ID

You might also like

Download as docx, pdf, or txt
Download as docx, pdf, or txt
You are on page 1of 1

REPUBLIC OF THE PHILIPPINES | S. S.

DONE: IN THE CITY OF BAGUIO |

AFFIDAVIT OF LOSS

I, KATE DHAREEN V. EUGENIO, of legal age, married, Filipino, and a


resident of FB 204 Pines Park, La Trinidad, Benguet, Philippines, after being sworn
in accordance with law, hereby depose and state—

1. In connection with my being Administrative Officer I of the Baguio


General Hospital and Medical Center, I was issued an employee identification card.

2. I recently discovered that my said employee identification card is missing.


I could no longer find it in my files or belongings. All my efforts to locate or retrieve
it were all in vain; hence it is now deemed lost and beyond recovery. I certify and
confirm that the said employee identification card was neither confiscated nor
relinquished in favour of any government institution, office, agency or entity.

3. I attest to the truth of the foregoing statements to the best of my own


personal knowledge and based on authentic documents and records. I am executing
this Affidavit of Loss to support my application with Baguio General Hospital and
Medical Center for the issuance of a new employee identification card in lieu of the
one that was lost as well as for all other lawful intents and purposes it may serve.

IN WITNESS WHEREOF, I set my hand this 12th day of February 2019 at


Baguio City, Philippines.

KATE DHAREEN V. EUGENIO


Affiant

SUBSCRIBED AND SWORN to before me this 12th day of February 2019 at


Baguio City, Philippines, affiant personally known to the undersigned.

ATTY. OSCAR A. CORPUZ, JR.


Notary Public
Until December 31, 2019
N. A. No. 32-NC-18-R
IBP No. 05108 12.04.2018 for 2019 Baguio City
PTR No. 3884977 12.03.2018 for 2019 Baguio City
Doc. No. 125
Room 202 2/F Otek Business Centre
Page No. 25 No. 13 Otek Street, Baguio City 2600
Book No. IX
Series of 2019

You might also like