Republic of the Philippines )

Province of Surigao del Norte )

City of Surigao ) S.S.
x -----------------------------------x

AFFIDAVIT OF LOSS OF IDENTIFICATION CARD

I, TARCILA MANLIGUIS BINGA, Filipino, of legal age, single, and a resident of

Purok Bonifacio, Brgy. Poblacion, Purok-1, Bacuag, Surigao Del Norte after being duly
sworn to in accordance with law, hereby depose and say:

1. That I am a holder of a Senior Citizen’s Identification Card issued by the

Office of the Senior Citizens Affair Office in the municipality of San Jose,
Dinagat Islands;

2. That I used to put said identification card in my pouch;

3. That sometime on March 8, 2024, while riding a tricycle I left the pouch
containing my Senior Citizen’s Identification Card;

4. That I have already exhausted remedies to find and restore possession of

the said identification card;

5. That despite diligent efforts to find and recover possession of the

aforementioned identification card, I could not find the same such that I
now believe that it is now lost beyond recovery;

6. That said identification card was not confiscated by the authorities by

reason of any violation of relevant laws and statutes;

7. That I am executing this affidavit to attest to the truth of the foregoing facts
and request for a replacement of the said Senior Citizen’s Identification
Card.

IN WITNESS WHEREOF, I have hereunto set my hand this 16th day of March at
Surigao City, Surigao del Norte, Philippines.

TARCILA MANLIGUIS BINGA

Affiant

SUBSCRIBED AND SWORN to before me this 16th day of March 2024 at Surigao City,
Surigao Del Norte, Philippines, affiant exhibiting to me her Cedula bearing the number
28453501 issued at Brgy. Poblacion, Bacuag, Surigao del Norte on March 16, 2014 as
her competent evidence of identity.