REPUBLIC OF THE PHILIPPINES)

CITY OF KIDAPAWAN ) SS.

AFFIDAVIT OF LOSS

I, GRACE MINDA P. BERGANTINOS, of legal age, married, Filipino

and a resident of Brgy. Singao, Kidapawan City, after having been duly sworn
under oath in accordance with law hereby voluntarily depose and say:

1. That I am the holder/owner of a certain OSCA I.D issued to me by

Office of the Senior Citizen Association , Kidapawan City;

2. That I was responsible for the safekeeping of the said OSCA I.D;

3. That just recently, I looked for said OSCA I.D but I could not locate the
same. I might have misplaced the it;

4. That despite diligent search I could no longer find the said OSCA I.D
and it is now considered lost;

5. That I am executing this Affidavit to attest to the truth of the foregoing

facts and for whatever legal purpose this may serve.

IN TRUTH WHEREOF, I have hereunto signed my name this 28 th day of

January 2020 in Kidapawan City.

GRACE MINDA P. BERGANTINOS

Affiant
OSCA FEDERATION ID: 2837

SUBSCRIBED AND SWORN to before me in the City of Kidapawan, Philippines this

28th day of January 2020, by affiant/s who exhibited to me his/her/their competent
evidence identity as indicated below his/her/their name/s.

ANGELI NESS CASADOR EVANGELISTA
Doc. No. ___; Notary Public
Page No. ___; Notarial Commission Serial No. 135-2019
Book No. I; Commission Expires on December 31, 2021
Series of 2020. Roll of Attorneys No. 61857
PTR No. 2144813; 01/03/2020; Kidapawan City
IBP O.R. No. 102281; 01/02/2020; Pasig City
CITY LEGAL OFFICE
CITY HALL BUILDING, DE MAZENOD AVE.,
KIDAPAWAN CITY, PROVINCE OF COTABATO