REPUBLIC OF THE PHILIPPINES)

CITY OF CAGAYAN DE ORO ) S. S.

AFFIDAVIT OF LOSS

I, VICENTA MERLAS y MACALAGUING, of legal age, widow,

and a resident of South View Homes, Macasandig, Cagayan de Oro City,
after having been duly sworn to an oath in accordance with law, hereby
depose and say, that:

1. I was a holder of a Senior Citizen Identification Card, issued in

2008 by the Office of the Senior Citizen – Cagayan de Oro
Chapter, Cagayan de Oro City;

2. Sometime in August 2009, I inadvertently lost the said

identification card when I left the same in the passenger jitney
I was riding; and that I searched and looked for it however, the
same could not be located for it is now beyond recovery; and

3. This Affidavit is executed to attest to the truth of the foregoing

statement, and to support my application for an issuance of a
new Senior Citizen Identification Card.

IN WITNESS WHEREOF, I have hereunto set my hand and

affixed my signature this 8th day of September, 2009, at Cagayan de Oro
City, Philippines.

VICENTA MERLAS y MACALAGUING

Affiant

SUBSCRIBED AND SWORN to before me on the date and place

above-written by the Affiant having presented to me his identification card
number