REPUBLIC OF THE PHILIPPINES )

PROVINCE OF PAMPANGA ) S.S

CITY OF SAN FERNANDO )

AFFIDAVIT OF LOSS
I, __________________________________, Filipino, of legal age,
single, and resident of __________________________________, Pampanga,
after being duly sworn in accordance with law, depose and state that:

1. I am a bona fide Solo Parent, having qualified to be one in

accordance with pertinent laws;

2. As proof of such fact, I was issued an ID, which I would regularly

use;

3. Sometime this June 2020, I applied for an aid for solo parents. As
such, one requirement is the Solo Parent ID;

4. It was only then that I realized that I could not locate my ID;

5. Despite diligent search and efforts to locate the said ID, I could
not find the same, such that I believe that it is now lost beyond recovery;

6. As such, I am executing this Affidavit of Loss to attest to the truth

of the foregoing and for any legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

_________________ in the City of San Fernando, Pampanga.

_______________________________
Affiant

SUBSCRIBED AND SWORN to before me this _________________

in the City of San Fernando, Pampanga, the affiant exhibiting to me her
___________________ with ID No. _________________ as competent proof
of her identity.

Doc No. ______

Page No. ______ Notary Public
Book No. ______
Series of 2020