REPUBLIC OF THE PHILIPPINES)

CITY OF MAKATI ) S. S.

AFFIDAVIT OF LOSS

That I, KARLA DENISSE VALDEZ YUMUL, of legal age, Filipino citizen, with
residence address at 1517 D. Oliman Street, Valenzuela, Makati City, after having duly
sworn to in accordance with the law do hereby depose and state that:

I am a holder and possessor of Vaccination Card for booster issued by Government

of Makati;

The discovery in the loss of aforesaid item has been established, due to
circumstances beyond knowledge; whereof, assuming that the same misplaced and could
no longer be found;

Diligent effort has been exerted but futile; therefore, considered it lost for all intents
and purposes;

I am executing this Affidavit to attest to the truth of foregoing facts, for information
and guidance of proper authorities concerned and for whatever legal purpose this may
serve.

AFFIANT SAYETH NAUGHT.

IN WITNESS WHEREOF, I hereunto set my hand on this 07 th day of October 2022, in

the City of Makati.

KARLA DENISSE VALDEZ YUMUL

Affiant

SUBSCRIBED AND SWORN to before me on this 07th day of October 2022, in the City
of Makati, Philippines.

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SERIES OF: 2022.