REPUBLIC OF THE PHILIPPINES)

CITY OF LAPU-LAPU ) S.S.

AFFIDAVIT OF LOSS

I, FAITH JOY PARILLA CHORESCA, of legal age, Filipino and a resident

of Calawisan, Lapu-Lapu City, Cebu, Philippines, after having been sworn to in
accordance with law, hereby depose and say:

1. That I am currently working as a NURSE at ARC Hospital and was

consequently issued a Hospital Identification Card;

2. That sometime December 3, 2021, I was driving my motorcycle along the

road of Cordova, Cebu. I remember having placed my ID in one of the side
pockets of my bag;

3. That upon reaching my destination, I noticed that my ID is no longer inside

the side pockets of my bag and was afraid that I might have dropped it
while driving;

4. That I tried to locate the said Identification Card but to no avail as the
same were lost and I could no longer find the same.

5. As such, I am executing this Affidavit of Loss to attest to the truth of the

foregoing and to support my application for the issuance of a new
Identification Card, in lieu of the one that I lost.

IN WITNESS WHEREOF, I have hereto set my hand this 13th day of

December 2021 at Lapu-Lapu City, Philippines.

FAITH JOY PARILLA CHORESCA

Affiant

SUBSCRIBED AND SWORN TO BEFORE ME this 13th day of

December 2021 at Lapu-Lapu City, Philippines. Affiant exhibited to me her
government issued ID as her competent proof of identity.

Doc No. :_____;

Page No. :_____;
Book No. :_____;
Series of 2021.