Republic of the Philippines)

City of Cagayan de Oro )S.S.

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AFFIDAVIT

I, SWEET KARREN M. PACULANAN, of legal age, Filipino,

single, and a resident of no. 2186 Macajalar, Caman-an, Cagayan de
Oro City, after having been duly sworn to law, hereby depose and say:

1. That I am at present a student at USTP, Cagayan de Oro and,

as such, vaccinated with two doses of Pfizer vaccine held at
SM downtown, Upper Carmen, Cagayan de Oro City;

2. That because of this, I was issued a Vaccination Card issued

by the Department of Health;

3. That, however, last January 24, 2022, the said Vaccination

Card was placed inside my shoulder bag when I was at SM
Downtwon and going to the city proper and after I was home, I
noticed that the said card cannot be found in my bag;

4. That despite my diligent and exhaustive efforts exerted to

locate and recover my said Vaccination Card, the same only
proved futile;

5. That I am executing this affidavit to attest to the veracity of the

foregoing facts and statements for the issuance of a new
Vaccination Card and for whatever legitimate purpose this may
serve.

IN WITNESS WHEREOF, I have hereunto set my hand this

th
24 day of January, 2022, at Cagayan de Oro City, Philippines.

SWEET KARREN M. PACULANAN

-Affiant-

SUBSCRIBED AND SWORN TO before me this 28th day of

January, 2019, at Cagayan de Oro City, Philippines, affiant exhibited to
me her USTP school ID No. 2013102176 as the same person who
executed this affidavit.