REPUBLIC OF THE PHILIPPINES)

CITY OF ILOILO) S.S.

X-----------------------------------------X

AFFIDAVIT OF LOSS

I, CHRISTINA HECHANOVA y CASAS, of legal age, single, Filipino citizen, and

a resident of Brgy. Purok II, Pavia, Iloilo, Philippines, after having been duly sworn to in
accordance with law, hereby depose and state THAT:
1. I am a holder of a PhilHealth ID issued by the Philippine Health Insurance
Corporation in Passi City, Iloilo which I usually keep inside my wallet;
2. Sometime around February 23, 2022, when I was organizing the contents of my
wallet, I discovered that my PhilHealth ID Card was missing. I tried to look for it
in my other wallets but I did not find the same. Also, I asked my household
members if they have seen it but all answered in the negative;
3. Despite diligent efforts exerted, I could not locate or recover the said PhilHealth ID
Card, and to the best of my knowledge, the same is truly lost;
4. My PhilHealth ID Card was never used as a security to any obligation;
5. I am executing this affidavit to attest to the truth of the foregoing statements and
for the purpose of securing another PhilHealth ID and for all legal intents and
purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 28th day of February
2022 at Iloilo City, Philippines.

CHRISTINA HECHANOVA y CASAS

Affiant

SUBSCRIBED AND SWORN to before me, a Notary Public for and in the City and
Province of Iloilo, Philippines, on this 28th day of February 2022 at Iloilo City, Philippines.
Affiant personally appeared before me, signed the foregoing document in my presence, and
attested under oath as to the truthfulness of the allegations contained therein. I further
identified her through her competent evidence of identity which is her Voter’s
Identification Card with Number VIN: 3013-0097B-B2490CCH20000 issued at Pavia,
Province of Iloilo.

BEVERLY C. CORPUS
Notary Public
Notarial Commission Number 900002122
Until December 31, 2023
PTR No. 7894166
Issued on February 2, 2022 at Iloilo City
IBP Receipt No. 143789
Issued on February 21, 2022 at Makati City
MCLE Compliance No. VI-0009999/Until August 15, 2022
Roll of Attorneys No. 100670
Ungka, Jaro, Iloilo City
Tel. No. 033 512 7600
Email: bccorpus@yahoo.com

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