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REPUBLIC OF THE PHILIPPINES)

CITY OF ZAMBOANGA..) S.S.


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AFFIDAVIT OF LOSS
I, TIFFANY A. BERBANO, of legal age, Filipino, single and a
resident of Waray Drive, Don Alfaro St., Tetuan, Zamboanga City,
after having been sworn to in accordance with law, hereby depose
and state:
1. That I am the holder of the Philippine Health
Insurance Corp., Identification Card (PHILHEALTH ID)
and Tax Identification Number (TIN);
2. That said ids were regularly placed in my wallet for
identification purposes;
3. That on March 28, 2016, due to an inadvertence, I
discovered that the same were no longer in my wallet
and consider it lost for all legal intents and purposes;
4. That I am executing this affidavit to attest to the
veracity of the foregoing statements and for the
issuance of a new one in lieu of the loss.
IN WITNESS WHEREOF, I have hereunto set my hand and
affixed my signature this 5th day of April, 2016 at Zamboanga City,
Philippines.

TIFFANY A. BERBANO
Affiant
SUBSCRIBED AND SWORN to before me on the above date
and place.

REPUBLIC OF THE PHILIPPINES)


CITY OF ZAMBOANGA..) S.S.
X---------------------------------------X
AFFIDAVIT OF LOSS
I, ANGELIE LEONG, of legal age, Filipino, single and a resident
of Sta. Maria, Zamboanga City, after having been sworn to in
accordance with law, hereby depose and state:
5. That I am the accountant of Golden Haven Memorial
Park Inc.;
6. That said office paid the required amount for the
printing of official receipt to be surrendered to Freedom
Commercial Printers, Inc. as accredited by BIR and was
issued an Authority to Print and Form 1906;
7. That on October 23, 2015, I am about to surrender said
forms and the same can no longer be found along with
my other documents where I kept;
8. That due to an inadvertence, the same can no longer be
found and consider it lost for all legal intents and
purposes;

9. That I am executing this affidavit to attest to the


veracity of the foregoing statements and for the printing
of the requested official receipts of our company.
IN WITNESS WHEREOF, I have hereunto set my hand and
affixed my signature this 6th day of November, 2015 at Zamboanga
City, Philippines.

ANGELIE LEONG
Affiant
SUBSCRIBED AND SWORN to before me on the above date and
place.

REPUBLIC OF THE PHILIPPINES)


CITY OF ZAMBOANGA..) S.S.
X---------------------------------------X
AFFIDAVIT OF LOSS
I, RIFAT A. CUEVAS, of legal age, Filipino, single and a
resident of Tetuan, Zamboanga City, after having been sworn to in
accordance with law, hereby depose and state:
10. That I am a previous employee of Primeplus
Promotion & Outsourcing Inc., as Merchandiser;
11. That on August 6, 2015, I was terminated for said
employment and was issued a Waiver/Quitclaim
thereof;

12. That sometime in the first week of October, 2015,


when I was about to claim my separation pay, I
noticed that the original copy of my Waiver/Quitclaim
was no longer in my folder along with my other
documents where I kept;
13. That due to an inadvertence, the same can no
longer be found and consider it lost for all legal
intents and purposes;
14. That I am executing this affidavit to attest to the
veracity of the foregoing statements and for the
issuance of a new one in lieu of the loss.
IN WITNESS WHEREOF, I have hereunto set my hand and
affixed my signature this 7th day of October, 2015 at Zamboanga
City, Philippines.
RIFAT A. CUEVAS
Affiant
SUBSCRIBED AND SWORN to before me on the above date
and place.

REPUBLIC OF THE PHILIPPINES)


CITY OF ZAMBOANGA..) S.S.
X---------------------------------------X
AFFIDAVIT OF LOSS

I, FREDESVINDO C. FABIAN, of legal age, Filipino, married


and a resident of Zambowood, Zamboanga City, after having been
sworn to in accordance with law, hereby depose and state:
15. That I am a holder and a member of the Philippine
Health Insurance Corp., (PHILHEALTH), Zamboanga
City and was issued an identification card;
16. That said card was regularly placed in my cabinet
at home for safe keeping;
17. That sometime on the month of September, 2015,
due to an inadvertence, I discovered that the same
was no longer where I kept and can no longer be
found and consider it lost for all legal intents and
purposes;
18. That I am executing this affidavit to attest to the
veracity of the foregoing statements and for the
issuance of a new one in lieu of the loss.
IN WITNESS WHEREOF, I have hereunto set my hand and
affixed my signature this 6th day of October, 2015 at Zamboanga
City, Philippines.
FREDESVINDO C. FABIAN
Affiant
Senior Citizen ID No. 039610
SUBSCRIBED AND SWORN to before me on the above date
and place.

REPUBLIC OF THE PHILIPPINES)


CITY OF ZAMBOANGA..) S.S.
X---------------------------------------X
AFFIDAVIT OF LOSS
I, ZOREN KIER T. MIGUEL, of legal age, Filipino, single and a
resident of Tomas Claudio Ext., Zamboanga City, after having been
sworn to in accordance with law, hereby depose and state:
19. That I am a holder and a member of the Philippine
Health Insurance Corp., (PHILHEALTH), Zamboanga
City and was issued an identification card;
20. That said card was regularly placed inside my
wallet for safe keeping;
21. That sometime on the month of June, 2015, due to
an inadvertence, I discovered that the same was no
longer in my wallet and can no longer be found and
consider it lost for all legal intents and purposes;
22. That I am executing this affidavit to attest to the
veracity of the foregoing statements and for the
issuance of a new one in lieu of the loss.
IN WITNESS WHEREOF, I have hereunto set my hand and
affixed my signature this 5th day of August, 2015 at Zamboanga
City, Philippines.
ZOREN KIER T. MIGUEL
Affiant
SUBSCRIBED AND SWORN to before me on the above date
and place.