Republic of the Philippines )

City of El Salvador ) S.S.

AFFIDAVIT OF LOSS

I, SERGIO DELA GUIARDIA ALIBUTOD, 81 years old,

married, and a resident of #681 Zone 6, Barangay Bayabas,
Cagayan de Oro City, Misamis Oriental, Philippines, after
having been duly sworn to an oath in accordance with the law,
hereby depose and say:

1. That I am the owner of a Senior Citizen ID issued by Office

for the Senior Citizen Affairs of Cagayan de Oro City;
2. That I lost my Senior Citizen ID sometime last 2021 when
I went to Metro Manila;
3. That despite due diligence and earnest efforts to locate it,
the same proved futile;
4. That the said Senior Citizen’s ID was not confiscated by
any officer of the law by the reason of any violation of any
law, ordinance, or presidential decree, rules, or
regulations of the said office.
5. That I am executing this Affidavit to inform OSCA Cagayan
de Oro City that the said Senior Citizen’s ID was lost and
never recovered; and
6. That I attest to the truth of the foregoing facts.

FURTHER AFFIANT SAYETH NONE.

IN WITNESS WHEREOF, I have hereunto set my hand this

13th day of June 2023, in El Salvador City, Misamis Oriental,
Philippines.

SERGIO DELA GUIARDIA ALIBUTOD

Affiant

SUBSCRIBED AND SWORN TO before me this 13th day of

June 2023, in El Salvador City, Misamis Oriental, Philippines,
affiants exhibiting his valid Government-issued ID for
identification.