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Affidavit of Loss - Philhealth ID Wallet
Affidavit of Loss - Philhealth ID Wallet
______________________________
Affiant
-OATH-
Republic Of The Philippines)
City Of . . . . . . . . . . )S.S.
X - - - - - - - - - - - - X)
SUBSCRIBED AND SWORN to before me this
_______________________, exhibiting competent evidence of his
identity through his _____________________ issued by the
______________________________________, Philippines.