Republic of the Philippines )

City of Tacloban )

AFFIDAVIT OF LOSS
I, PRIMA APOLONIO POLLESCAS, Filipino, of legal age, married and a resident of
Marasbaras, Tacloban City, Philippines after having been duly sworn to in accordance with law do hereby
depose and say:

1. That I am a bonafide and active member of the Senior Citizen Association (OSCA) of
Tacloban City;

2. That as such I was issued a corresponding Senior Citizen ID by the LGU of Tacloban City with
OSCA ID No. 3611648;

3. That lately, I noticed that the said ID was lost without my knowledge and believed to
have been lost or misplaced together with my other documents;

4. That for all intents and legal purposes, I considered it lost and beyond recovery;

5. That I am executing this affidavit to attest the truth and veracity of all the foregoing
statements.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 8th day of August
2022 at Tacloban City, Philippines.

PRIMA APOLONIO POLLESCAS

Affiant
ID No. ______________________
Issued by __________________

SUBSCRIBED AND SWORN to before me this 8th day of August 2022 at Tacloban City,
Philippines.

Doc. No. _____

Page No. _____
Book No. _____
Series of 2022.