Republic of the Philippines)

Province of Cagayan) S.S.

City of Tuguegarao)
x ------------------------------------x
AFFIDAVIT OF LOSS

I, MARLINA FATIMA E. TURINGAN, Filipino, of legal age, single and with

residence at #11 Mallillin St., Ugac Norte, Tuguegarao City, Cagayan, after
being duly sworn to in accordance with law, hereby depose and state that:

1. Sometime

in

the Association

April

2015,

of

Nursing

was

issued

Service

an

IVT

Card

by

of

the

Administrators

Philippines(ANSAP);
2. I usually keep my IVT card inside my document organizer;
3. Last week when I was trying to search for my IVT card, I noticed
that it was missing;
4. Despite diligent efforts to locate the said IVT Card, I could not
locate the same hence, I considered it to be lost beyond recovery;
5. As such, I am executing this Affidavit of Loss to attest to the
truth of the foregoing and to secure a new card, in lieu of the one
that was lost.

IN WITNESS WHEREOF, I have hereunto set my hand this 11th day of

February 2016 at Tuguegarao City, Cagayan, Philippines.

MARLINA FATIMA E. TURINGAN

Affiant

PRC ID No. 0668201

SUBSCRIBED and SWORN to before me this 11th day of February
2016 at Tuguegarao City, Cagayan.

Doc No._________;
Page No._________;
Book No._________;
Series of 2016.