Republic of the Philippines……)

Province of Negros Oriental…) S.S.

City of Dumaguete……………)

AFFIDAVIT OF LOSS

I, ERLE ZANE R. YCAZA, Filipino, of legal age, married and a resident of

Dauin, Negros Oriental, Philippines, after having been sworn to in accordance
with law, hereby depose and say:

1. That I am the owner of a certain Medical Card and Airmen’s License

No. 110219-ATC duly issued by Civil Aviation Authority of the
Philippines;

2. That sometime in October 2019, the said cards were misplaced;

3. That I took pains to look for the cards but to no avail;

4. That I am executing this affidavit to attest to the truth and veracity of the
foregoing declarations and to support whatever purposes this may
lawfully serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 6th day

of November 2019 at Dumaguete City, Philippines.

ERLE ZANE R. YCAZA

Affiant

SUBSCRIBED AND SWORN to before me this 6th day of November 2019

at Dumaguete City, Philippines Affiant exhibited to me his CAAP ID No. 4574,
bearing his signature and photograph to be the same person who executed this
instrument in my presence and jurisdiction and avowed of the truth of the
contents thereof under the penalty of law.

Doc. No._____;
Page No._____;
Book No._____;
Series of 2019