Loss Florita Dizon de Leon

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REPUBLIC OF THE PHILIPPINES)

CITY OF MANILA )S.S.

AFFIDAVIT OF LOSS

I, FLORITA DIZON DE LEON, of legal age, Filipino, Single, with residence and
postal address located at 1215 B-P. GUEVARRA ST.STA CRUZ, MANILA after having been
duly sworn to in accordance with law, hereby depose and say:

1. That, I am an owner of SENIOR CITIZEN ID (ID NOS. 063045). Issued OFFICE


FOR SENIOR CITIZEN AFFAIRS, CITY OF MANILA.

2. On or around JULY 15, 2019 , I discovered that the said ID was missing while
I'm about to go home.

3. That, I am executing this affidavit to establish of the foregoing facts and for
whatever legal purpose it may deem serve.

AFFIANT SAYETH NAUGHT.

FLORITA DIZON DE LEON

Affiant

SUBSCRIBED AND SWORN to before me this _____ day of ______________


2019 at the City of Manila.

Doc. No. _____; NOTARY PUBLIC


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

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