REPUBLIC OF THE PHILIPPINES)

LAPU LAPU CITY) SS

AFFIDAVIT OF LOSS

I, ERIC ANDRE C. CALAGO, of legal age, single, residing at Gun-ob, Carahay, Lapu Lapu
City, Philippines, after being sworn in accordance with law, depose and say:

1. That I have been fully-vaccinated with Astrazeneca Vaccine last September 2022;

2. That due to the abovementioned Vaccination, I was duly issued a Vaccination Card;

3. That I kept the above said item on our altar;

3. However, the above-mentioned item was lost in my possession when the typhoon
Odette destroyed our area last December 16, 2021;

4. That despite diligent search and effort exerted to locate the said Vaccination Card, but
the same proved futile; hence, the same should now be considered lost;

5. I am executing the instant Affidavit to attest the veracity of the foregoing statements
and for the issuance of a new above-mentioned item Vaccination Card in lieu of the lost
one, and for whatever legal purposes this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this March 17, 2022, in
Lapu Lapu City, Philippines.

ERIC ANDRE C. CALAGO

Affiant
ID No.: 9385-3198-4280-4657
Philippine Identification Card

SUBSCRIBED AND SWORN to before me this 18th day of March 2022 at Lapu-
Lapu City, Philippines, affiant personally known to me with his competent evidence of
identity abovementioned to be the same person who executed the foregoing affidavit
and avowed, and who signed this instrument in my presence, and avowed under the
penalty of law to the whole truth of its contents.

Doc. No. ____;

Page No. ____;
Book No. ___;
Series of 2022.