Republic of the Philippines)

DONE: CITY OF BAGUIO…..) S.S.

AFFIDAVIT OF LOSS
I, JOEL P. TABINGAN, of legal age, married, Filipino Citizen, with
residence and postal address at FE-135, Km. 3, Botiwtiw, Balili, La Trinidad,
Benguet Philippines, after having been duly sworn to in accordance with law do
hereby deposes and states, that:

1. I am a Senior Citizen and member of the Senior Citizens Affairs-La

Trinidad Chapter;

2. Being a Senior Citizen, I was issued a Senior Citizen Identification Card

bearing Senior Citizen ID No. 15802 which was issued on March 25,
2022;

3. On December 23, 2023, I went to BSU, La Trinidad, Benguet and went to

Jollibee at Km, 5, La Trinidad, Benguet. I used my said Senior Citizen ID
Card when I took my order. However, that was the last time that I saw
my Senior Card;

4. I exerted diligent effort to find my said Senior Card in all my pockets and
inside my bag but the same could not locate it. Maybe it fell-off from my
pocket without me noticing it;

5. The said Senior Citizen ID Card was not given nor pledged to anyone for
any purpose whatsoever, nor was taken or confiscated by the authorities
for violation of any law;

6. I am executing this affidavit to attest to the truth of my foregoing

statements and to support my request for the replacement of my same
Senior Citizen ID Card and for all legal intents and purposes it may
serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 26th day of

December, 2023 at Baguio City, Philippines.

JOEL P. TABINGAN
Affiant
Driver’s Lic. No. A01-71-004372
Valid Until: 9-08-2033

SUBSCRIBED AND SWORN TO before me this 26th day of December,

2023 at Baguio City, Philippines. Affiant personally appeared before me to be
the same person who executed this instrument as his free act and deed.

MODESTO T. ANDONG
Notary Public
Comm. N.A.-56-NC-22-R until Dec. 31, 2024
PTR No. 4902764/1-04-2023
IBP OR No. 271717/1-5-2023
ROLL No. 31289/5-15-81/Manila
Doc. No. 190; BIR TIN No. 121-017-652-000
Page No. 38; ANDONG and NEBATEN LAW OFFICE
Book No. 76; No. 19 2nd flr., Old Market Building,
Series of 2023. Upper Magsaysay Ave., Baguio City, 2600