REPUBLIC OF THE PHILIPPINES)

MUNICIPALITY OF AGOO )S.S

PROVINCE OF LA UNION )
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AFFIDAVIT OF LOSS

I, ESTELA PAGAR MANAPAT, of legal age, Filipino citizen, married

and residing at Barangay San Julian East, Agoo, La Union after being duly sworn,
hereby depose and state:

1. That I am a holder of a Senior Citizen Identification Card issued by the

Office for Senior Citizens Affairs-Agoo, La Union;

2. That I usually placed and kept the said ID inside my bag;

3. That when I needed and checked the said identification card, it was no
longer in my bag where I kept it;

4. That its whereabouts cannot be ascertained despite due and diligent search
undertaken;

5. That in view thereof, I am now requesting the OSCA-Agoo, La Union to

issue a new Senior Citizen ID in lieu of the one lost;

6. That I am executing Affidavit to attest to the truthfulness of the foregoing

and for all legal intents and purposes it may serve

IN WITNESS WHEREOF, I have hereunto set my hand this 30 th day of July

2020, in the Municipality of Agoo, La Union, Philippines.

ESTELA PAGAR MANAPAT

Affiant
UMID-LGU-AGOO, LA UNION
ID No. W247

SUBSCRIBED AND SWORN TO before me this 30 th day of July 2020, in

the Municipality of Agoo, La Union, Philippines.