REPUBLIC OF THE PHILIPPINES)

City of Mandaue) S.c.

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AFFIDAVIT of LOSS

I, GEMELIO J. REDIJA JR., of legal age, single, Filipino citizen, and a resident of Z1-
019 Plaridel St., Looc, Mandaue City, Philippines, after having been duly sworn in accordance
with law, hereby depose and say:

1. That I am a Professional Nurse of which I was issued a PRC ID;

2. That I kept the said PRC ID inside my wallet which I placed inside my pocket;

3. That on sometime March 18, 2019 near Apple One, Ayala Mall, Mabolo, Cebu City,
while I then discovered that the said PRC ID together with my wallet which is inside my
pocket was no longer there, of which I suspected it could have slipped;
4. That I do hereby attest that the said PRC ID was not in the lawful possession of any
person or entity as a collateral of a loan or was encumbered;
5. That despite diligent search and efforts to locate the said PRC ID, I could not find it such
that I now believe that it is now lost beyond recovery;

6. As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing facts
and for collection purposes, and for whatever legal purpose that this affidavit may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this March 19, 2019 at
Mandaue City, Philippines.

GEMELIO J. REDIJA JR.

AFFIANT

SUBSCRIBED AND SWORN to before me this March 19, 2019 at Mandaue City, by
affiant, GEMELIO J. REDIJA JR., who exhibited to me his Chong Hua Hospital ID No. 2016-
0121 known to me and to me known to me to be the same person who personally signed the
foregoing affidavit.

Doc. No.: _____;

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