REPUBLIC THE PHILIPPINES )

BATANGAS CITY ) S.S.

AFFIDAVIT OF LOSS

I, ROGELIO FESTIJO ANDAL, of legal age, Filipino, and a

resident of Alangilan, Batangas City, after having been duly
sworn to, in accordance with law, hereby, depose and state, that:

[1] I am 61 year old and I am a holder of an OSCA ID

with ID No. 04-10-05-001-1682 issued on December 2017 by the
Office of the Senior Citizens Affairs Batangas City;

[2] However, recently, as I was checking my personal

files, I found out that the mentioned ID is missing;

[3] I exerted diligent efforts to find and locate the said ID

but the same proved futile;

[4] Moreover, said ID has not been returned nor

surrendered to me by any finder/keeper;

[5] I am executing this affidavit to attest to the truth and

to inform the proper authorities particularly Office of the Senior
Citizens Affairs Batangas City of all the foregoing facts, and for
whatever legal purpose this Affidavit may serve.

IN WITNESS WHEREOF, I have hereunto set my hand

this 01 July 2019, at Batangas City.

ROGELIO FESTIJO ANDAL

Affiant

SUBSCRIBED AND SWORN TO BEFORE ME this 01

July 2019, at Batangas City.

SONNY JOSE M. RICABLANCA

Notary Public
Until 31 December 2020
PTR No. 330886001 01-03-19
Doc. No. Batangas City
Page No. IBP Lifetime No. 019079
Book No. XVII Roll No. 69544 Serial No. 2017-20
Series of 2019. Zenaida Arcade, 43 M.H. del Pilar
St., Batangas City