REPUBLIC OF THE PHILIPPINES) - FilipiKnow



REPUBLIC OF THE PHILIPPINES)

QUEZON CITY )S.S.

AFFIDAVIT OF LOSS

I, JUAN DELA CRUZ, of legal age, single, Filipino, with residence at Zone 1, San Fabian Street, Brgy. Del Monte, Quezon City, after having been sworn to in accordance with law hereby depose and say that:

1. I am a senior citizen and was issued a Senior Citizen ID by the Senior Citizen's Affairs Office of Quezon City.

2. Sometimes in the second week of August 2020, I tried to look for my Senior Citizen ID as I'll be buying a medicine. I suspect that I misplaced it somewhere in my house.

3. After a thorough search of all the areas in my house, I could not locate my Senior Citizen ID.

4. I took earnest efforts to look for the same and even asked the assistance of my household members but to no avail, hence said Senior Citizen ID is given up as lost.

5. I execute this affidavit to attest to the truthfulness and veracity of the foregoing facts, and for the purpose of securing another Senior Citizen ID, and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto signed my name this __________th day of September 2020 in Quezon City, Philippines.

JUAN DELA CRUZ

Affiant

      SUBSCRIBED AND SWORN to before me this _____ day of September 2020 in Quezon City Philippines. Affiant exhibited to me his competent evidence of identity as __________________.

Notary Public

Doc. No____;

Page No. ___;

Book No. ___;

Series of 2020.

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