Republic of the Philippines)

Zamboanga City . . . . . . . .)S.S.

x--------------------x

AFFIDAVIT OF LOSS

I, CATHERINE CHUA DUYONGCO, Filipino, of legal age, married and a resident of

250 Don Toribio, Tetuan, Zamboanga City, Philippines, after having been duly sworn to an oath
in accordance with law, depose and state:

That I am a bonfide member of the Philippine Health Insurance

Corporation (Philhealth);

That as such, I was issued an ID by the said government entity to be used

in case I need the services of a hospital should l get sick;

That recently, I found out that my said Philhealth ID was no longer in my

possession and was already missing;

That despite diligent efforts were exerted to locate my Philhealth ID, the
same proved futile and therefore, I consider it to be irretrievably lost;

That I am executing this affidavit for the purpose of establishing the

foregoing facts under oath, and to request the Philippine Health Insurance
Corporation, Zamboanga City to issue me a new ID, in lieu of the one that I lost,
and for whatever legal purpose this may serve.

IN WITNESS WHEREOF, I hereby voluntarily affix my signature this 20 th day of May,

at Zamboanga City, Philippines.

CATHERINE CHUA DUYONGCO

Affiant

SUBSCRIBED AND SWORN to before me this 20 th day of May, at Zamboanga City,

Philippines.

Republic of the Philippines)

Zamboanga City . . . . . . . .)S.S.
x--------------------x

AFFIDAVIT OF LOSS
 I, ESPERANZA YU CHUA, Filipino, of legal age, married and a resident of 250 Don
Toribio, Tetuan, Zamboanga City, Philippines, after having been duly sworn to an oath in
accordance with law, depose and state:

That I am a bonfide member of the Philippine Health Insurance

Corporation (Philhealth);

That as such, I was issued an ID by the said government entity to be used

in case I need the services of a hospital should l get sick;

That recently, I found out that my said Philhealth ID was no longer in my

possession and was already missing;

That despite diligent efforts were exerted to locate my Philhealth ID, the
same proved futile and therefore, I consider it to be irretrievably lost;

That I am executing this affidavit for the purpose of establishing the

foregoing facts under oath, and to request the Philippine Health Insurance
Corporation, Zamboanga City to issue me a new ID, in lieu of the one that I lost,
and for whatever legal purpose this may serve.

IN WITNESS WHEREOF, I hereby voluntarily affix my signature this 20 th day of May,

at Zamboanga City, Philippines.

ESPERANZA YU CHUA
Affiant

SUBSCRIBED AND SWORN to before me this 20 th day of May, at Zamboanga City,

Philippines.

Republic of the Philippines)

Zamboanga City . . . . . . . .)S.S.
x--------------------x

AFFIDAVIT OF LOSS

I, JOY CHUA UY, Filipino, of legal age, married and a resident of 250 Don Toribio,
Tetuan, Zamboanga City, Philippines, after having been duly sworn to an oath in accordance
with law, depose and state:
 That I am a bonfide member of the Philippine Health Insurance
Corporation (Philhealth);

That as such, I was issued an ID by the said government entity to be used

in case I need the services of a hospital should l get sick;

That recently, I found out that my said Philhealth ID was no longer in my

possession and was already missing;

That despite diligent efforts were exerted to locate my Philhealth ID, the
same proved futile and therefore, I consider it to be irretrievably lost;

That I am executing this affidavit for the purpose of establishing the

foregoing facts under oath, and to request the Philippine Health Insurance
Corporation, Zamboanga City to issue me a new ID, in lieu of the one that I lost,
and for whatever legal purpose this may serve.

IN WITNESS WHEREOF, I hereby voluntarily affix my signature this ___ day of

______, at Zamboanga City, Philippines.

JOY CHUA UY
Affiant

SUBSCRIBED AND SWORN to before me this this ___ day of ______, at Zamboanga
City, Philippines.

Republic of the Philippines)

Zamboanga City . . . . . . . .)S.S.
x--------------------x

AFFIDAVIT OF LOSS

I, JAMES CHUA UY, Filipino, of legal age, single and a resident of 250 Don Toribio,
Tetuan, Zamboanga City, Philippines, after having been duly sworn to an oath in accordance
with law, depose and state:

That I am a bonfide member of the Philippine Health Insurance

Corporation (Philhealth);
 That as such, I was issued an ID by the said government entity to be used
in case I need the services of a hospital should l get sick;

That recently, I found out that my said Philhealth ID was no longer in my

possession and was already missing;

That despite diligent efforts were exerted to locate my Philhealth ID, the
same proved futile and therefore, I consider it to be irretrievably lost;

That I am executing this affidavit for the purpose of establishing the

foregoing facts under oath, and to request the Philippine Health Insurance
Corporation, Zamboanga City to issue me a new ID, in lieu of the one that I lost,
and for whatever legal purpose this may serve.

IN WITNESS WHEREOF, I hereby voluntarily affix my signature this ___ day of

______, at Zamboanga City, Philippines.

JAMES CHUA UY
Affiant

SUBSCRIBED AND SWORN to before me this this ___ day of ______, at Zamboanga
City, Philippines.