AFFIDAVIT OF LOSS OF SENIOR ID CARD

REPUBLIC OF THE PHILIPPINES }

ZAMBOANGA CITY . . . . . . . . . . . . } S.S.

AFFIDAVIT OF LOSS

I, FAUSTINA F. ISIDRO, single/married/widow, of legal age, Filipino, with

residence and postal address at Mercedes, Zamboanga City, Philippines, after having
been duly sworn to in accordance with law hereby depose and state that:

1. I am a SENIOR CITIZEN;
2. By virtue of my SENIOR CITIZEN, I was issued an Identification Card;
3. Said Identification Card was lost sometime on ____________________
at home, Mercedes, Zamboanga City;
4. Hereunder are the facts and circumstances surrounding the loss of my
Identification Card:
That I always place my Senior Identification Card with bearning No.
_________________, at my personal Cabinet and when I check the said
Senior Citizen Identification card I was surprised that it was lost at my
cabinet that due to effort exerted to locate the same is not found and
beyond recovery;
5. I made diligent search to recover the said Identification Card but proved
futile;
6. For all legal intents and purposes the said Senior Citizen Identification
Card is now considered lost and beyond recovery;
7. I am executing this affidavit to attest to the truth of the foregoing and for
whatever legal purpose/s it may serve.

FURTHER AFFIANT SAYETH NAUGHT.

IN TRUTH THEREOF, I have hereunto set my hand this _____________ day of

___________________2019, at Zamboanga City, Philippines.

FAUSTINA F. ISIDRO
Affiant

SUBSCRIBED AND SWORN to before me this ___________________ day of

______________________ 20__ , affiant exhibited to me his/her Residence Cert. No.
__________________ issued at ___________________ on ______________________.

NOTARY PUBLIC

Doc. No. ___________;

Page No. ___________;
Book No. ___________;
Series of 2019