REPUBLIC OF THE PHILIPPINES )

PASIG CITY ) SS.

AFFIDAVIT OF LOSS

I, BABYCHELLE E. AURELLANA, of legal age and residing/with address at Kaimito St.

Manggahan, Pasig City, under oath, state:

1. THAT on 06 APRIL 2022 at PASIG CITY HALL while I was about to submit the
compliance requirements for the Sanitary Permit 2022, I noticed that my PASIG
HEALTH CERTIFICATE ID 2022 was nowhere to be found;

2. THAT I exerted diligent efforts to locate PASIG HEALTH CERTIFICATE ID 2022 but
to no avail and I therefore considered the same as lost and can no longer be found;

3. THAT I am executing this Affidavit to attest to the truth of the foregoing facts and to use
the same for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I hereunto affix my signature this _______________ at

__________________.

BABYCHELLE E. AURELLANA
Affiant

SUBSCRIBED AND SWORN to before me this _______________ at __________________,

Affiant exhibiting to me his Community Tax Certificate bearing No. ________________ issued
at _________________ on ___________________________, Pasig Health Certificate Card Id
2021 issued at Pasig City on 02/17/2021.

Doc No. ________;

Page No. _______ ;
Book No. _______;
Series of 2022.