Affidavit of Loss PhilHealth ID
The PhilHealth ID is a Philippines government-issued by Philippine Health Insurance Corporation (PhilHealth). This identification card can be used as a means of identification, for government-owned and controlled hospital and clinics that provide health services to Filipinos. It contains the member’s PhilHealth number, full name, birthdate, and other relevant information.
I, JUAN DELA CRUZ, of legal age, single, Filipino, with residence at Quirino Street, Paco, Manila, after having been sworn to in accordance with law, hereby depose and say that:
1. I am a holder of a PhilHealth ID issued by the Philippine Health Insurance Corporation in Fairview, Quezon City.
2. On 06 July 2020, while I was on board a taxi, on my way to Robinsons Place, Padre Faura, Manila, I have with me a small black pouch containing my PhilHealth ID, other small items, and coins. The small pouch was placed inside my bag.
3. When I get off the taxi, I have still had my bag with me, but I was not aware that my small pouch was no longer inside.
4. I just noticed that the small pouch was already missing when I was inside the Robinsons Place and about to get the coins from my bag to pay the item I bought.
5. I took earnest efforts to locate my pouch but to no avail. I suspect that it must have fallen from my bag without me noticing it; hence, I gave up and considered it as lost.
6. I execute this affidavit to attest to the truthfulness and veracity of the foregoing facts, and for the purpose of securing another PhilHealth ID, and for whatever purpose it may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of September 2023 in Manila , Philippines.
JUAN DELA CRUZ