REPUBLIC OF THE PHILIPPINES)

QUEZON CITY ) S.S. 
                                                     

AFFIDAVIT OF LOSS
 

I, KRISTEL MARIE D. BERTULDO, of legal age, single, Filipino, with residence at

Brgy. Sinikway, Lapuz, Iloilo City, after having been sworn to in accordance with law
hereby depose and state that:
 
1. I am an employee of Iloilo City Hall – Office of the Senior Citizens Affairs. As
such, I was issued an Employee ID.

2. On 23 April 2021, while I was at the Iloilo City Hall, I place the aforementioned
Employee ID inside my pocket but when I took it out to use it, it was not
already there and I could not find it.

3. I took pains to look for the ID, but to no avail; hence, the same was declared
lost.

4. I execute this affidavit to attest to the truth of the foregoing, and to secure

another Employee ID, and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 26th day of April, 2021
at Iloilo City, Philippines.                 
                   

KRISTEL MARIE D. BERTULDO

Affiant
        
 
      SUBSCRIBED AND SWORN to before me this 26th day of April, 2021 at
Iloilo City, Philippines. Affiant exhibited to me his competent evidence of identity as
__________________.

Notary Public

Doc. No____;
Page No. ___;
Book No. ___;
Series of 2021.