REPUBLIC OF THE PHILIPPINES)

City of Imus) S.S

AFFIDAVIT OF LOSS

I, MAY ANN P. BEJAR, of legal age, Filipino, married and residing at Blk 15 Lot
1 Saudia Village, Pag-Asa 2, City of Imus, Cavite after having been duly sworn to
according to law hereby depose and state:

1. My father-in-law Joselito D. Bejar is a member of the Office of the Senior

Citizen Association of Imus City (OSCA) with an identification card;

2. That I was given an Irrevocable Special Power of Attorney to be the true

attorney in fact of Joselito D. Bejar to execute this affidavit because of his
condition;

3. Sometime on February 20, 2024, while he was going to the Imus public
market his wallet was stolen together with his OSCA Identification Card.

4. However, he was trying to locate the said Identification card but to his utter
disbelief, the same was nowhere to be found.

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

6. Further, I am executing this affidavit of loss for the replacement of my father-

in-law's OSCA ID and for whatever legal purpose this may serve.

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

March 2024 at the City of Imus.

MAY ANN P. BEJAR

Affiant
Comelec Identification Card
Id No. VIN 2109-0521B-E078MPB20000

SUBSCRIBED AND SWORN to before me this __________day of March 2024 at

the City of Imus.

Notary Public

Doc. No.______
Page No.______
Book No._______
Series of 2024.