REPUBLIC OF THE PHILIPPINES.

)
PROVINCE OF SAMAR………..) SS
CITY OF CATBALOGAN……...)

AFFIDAVIT OF LOSS

I, MARIA L. NAVALLO, legal age, married, Filipino, and with residence at

Brgy. Igot, Villareal, Samar, after having been duly sworn to in accordance with law
do hereby depose and state: That –

1. I am the paternal aunt of Jake T. Siangco who was vaccinated with

Sinovac on September 28, 2021 for his first dose and on October 26, 2021
for his second dose in Tacloban City, Leyte;

2. As such, he was issued a vaccination card which he usually placed

inside his wallet wherever he goes;

3. Unfortunately, however, on 27 December 2021, his wallet containing

said vaccination cards was lost while he was driving a single motorcycle, and
its whereabouts could no longer be found despite efforts to locate it, hence. I
now consider the same lost for all intents and purposes;

4. This declaration of loss is not intended to defraud the government

specifically the City Health Office of Tacloban City and third persons and I
hereby absolve said agencies with any liabilities or responsibilities arising
from such loss;

5. I am executing this statement to attest the truth of all the foregoing

and to request, produce or issue a new vaccination card for my nephew, Jake
T. Siangco, in lieu of the one lost, and for other legal purposes.

IN WITNESS WHEREOF, I hereunto affix my signature this 11 th day of

January 2022 at Catbalogan City.

MARIA L. NAVALLO
Affiant

SUBSCRIBED AND SWORN to before me this 11 th day of January 2022,

Catbalogan City. Affiant exhibiting to me her OSCA ID No. 1333, issued by the LGU
Villareal, Samar on November 11, 2014.
REPUBLIC OF THE PHILIPPINES)
PROVINCE OF SAMAR…………..) SS
CITY OF CATBALOGAN………….)

AFFIDAVIT OF LOSS

I, AMWIL ISANAN MAGLENTE, of legal age, married, Filipino and with

residence at Brgy. Guinsorongan, Catbalogan City, Samar, after having been duly
sworn to in accordance with law do hereby depose and state that:

1. I am an employee of Roble Warehouse in Catbalogan City; as such, I

am a holder of several identification cards, particularly, LTO unexpired
driver’s license, UMID, PhilHealth, TIN card, and a holder of vaccine
card (Sinovac, first and 2nd shots) and booster vaccine card (Moderna
vaccine), which I usually placed in my wallet;

2. Unfortunately however, on 06 January 2022, while I was driving a

single motorcycle, I did not notice that my wallet with said ID cards,
dropped from my pants’ pocket and I discovered such loss only upon
reaching home;

3. Notwithstanding my efforts to locate my wallet with said ID cards, the

same proved futile such that I now considered said driver’s license
card, UMID, PhilHealth, TIN card, vaccine card and booster vaccine
card lost for all intents and purposes;

4. This statement is made in good faith and never intended to defraud

the government, its agencies and instrumentalities and third persons;

5. I am executing this statement to attest the truth of all the foregoing and
to request for replacement of said lost ID cards in lieu of the lost ones
with the concerned offices and for other legal purposes.

IN WITNESS WHEREOF, I hereunto affix my signature this 14 th day of January

2022 in Catbalogan City.

AMWIL ISANAN MAGLENTE

Affiant

SUBSCRIBED AND SWORN to before me this 14 th day of January 2022 at

Catbalogan City, affiant exhibiting to me her Non-Professional DL No. H01-19-
000662.