REPUBLIC OF THE PHILIPPINES )

IN THE CITY OF BATANGAS ) S.S.

x--------------------------------------------------x

AFFIDAVIT OF LOSS

I, JULIANA REYES y ILAGAN , of legal age, married, Filipino,

and a resident of M. Mendoza Road, Sta. Rita Karsada, Batangas City,
after having been duly sworn to in accordance with law hereby
deposes and states:

That I am a holder of a Senior Citizen ID Card with Control No.

04-10-05-097-2101 issued by the Office for Senior Citizens Affairs –
Batangas City;

That on 12 September 2020, I noticed that the said Senior

Citizen ID Card was missing;

That I made a diligent search in all places where it could

possibly be found but my search proved futile; and

That I am executing this Affidavit to make it known to all

authorities concerned of the loss of the above-mentioned ID for its
replacement, to affirm the truth of all I have stated above, and for
whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 5 th

day of October 2020 at Batangas City, Philippines.

JULIANA I. REYES
Affiant

SUBSCRIBED AND SWORN to before me this 5 th day of

October 2020 at Batangas City, Philippines.

Doc. No. OA-01020-0060;

Page No. 116;
Book No. 1;
Series of 2020.