REPUBLIC OF THE PHILIPPINES )

CITY OF CEBU ) S.S.

AFFIDAVIT OF LOSS

I, LUCRECIA A. COMON, of legal age, single, Filipino, born on January 14, 1954, and
a resident of 587 MJ Cuenco Avenue, Potat Bagumbayan, Sitio Sta. Lucia, Barangay Tinago,
Cebu City after having been duly sworn to in accordance with law, do hereby say that:

1. I am the bona fide holder/owner of a Senior Citizen’s I.D. issued by the City of
Cebu;

2. On February 27, 2024, a fire struck in Barangay Tinago, Cebu City that resulted
to the burning of our house. Included in the burned items are the above-
mentioned item.

3. Due to the fire, the item can longer be found, hence, considered lost forever;

4. I attest that the lost item was not used for illegal purposes nor to evade the
obligations and the authorities.

5. Finally, I am executing this affidavit based on personal knowledge and under

pains of perjury for the purpose of informing the authorities concerned, the fact
of loss of the above-mentioned item and so that the same will not be used by
anyone, with the final want that I’ll be issued a new one in lieu of the lost one.

IN WITNESS WHEREOF, I hereby affix my signature, this 3 rd day of March 2024 at

Cebu City, Cebu Philippines.

LUCRECIA A. COMON
Affiant

Two barangay officials who ascertained the identity of the affiant who lost all IDs:

NAME I.D. SIGNATURE

1) Reggy O. Sultan Driver’s License No. G01-15-008610

2) Joel G. Acob National I.D. 5026-5375-4169-3498

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Series of 2024.