REPUBLIC OF THE PHILIPPINES)

CITY OF COTABATO………………) SS.

x………………………………………..x

AFFIDAVIT

I, DR. AZISA G. ALONTO, of legal age, Filipino citizen, married, and a resident of
Pascual Street, MBRH, Cotabato City, Philippines, after having been duly sworn to in
accordance with law, depose and state:

1. That I am the same person who is a holder of official receipt of OBSERVER

FEE issued by the Philippine general Hospital, Manila for the whole month of
February, 2018;

2. That said receipt was kept by me and placed it inside my wallet for
safekeeping or for ready reference;

3. That quite by accident, on March 1, 2018 while I was in NAIA, said receipt
was drooped unnoticed and subsequently lost and despite diligent effort to
locate or to recover the same, it resulted in vain;

4. That I am executing this affidavit to establish the truth of all of the foregoing
statements, and for whatever legal intents or purposes that this affidavit may
serve.

IN WITNESS WHEREOF, I have hereunto set my hand and affixed my signature, this 8 th
day of March, 2018, in the City of Cotabato, Philippines.

DR. AZISA G. ALONTO

Affiant

SUBCRIBED AND SWORN to before me, this 8th day of March, 2018, in the City of
Cotabato, Philippines, affiant having exhibited to me her PRC ID Registration No. 0120507.

Doc. No. _______

Page No. _______
Book No. _______
Series of 2018