n REPUBLIC OF THE PHILIPPINES)

IN THE CITY OF LAOAG ) S.S.

AFFIDAVIT

I, NIDA CU ARELLANO, of legal age, single, Filipino Citizen and a resident of

Brgy. 1, Sitio West Maharlika, Ilocos Norte, Philippines, after having been duly sworn
to in accordance with law, hereby voluntarily depose and state:

That I am a lawful holder of a Person With Disability ID;

That I placed the above mentioned item inside my personal cabinet, and the
same was placed inside my house for safe keeping;

That sometime in 2017, my house was set on fire inasmuch that I was not able
to save my personal belongings including the said PWD ID;

That I exerted diligent efforts to redeem the same, but efforts turned futile;

That the said PWD ID has never been confiscated nor apprehended by any
authorities for violation of any rules;

That I am executing this affidavit to attest to the truth of the foregoing facts,
to request the proper authorities to issue me a copy of said ID, and for all legal
intents and purposes this may serve;

IN TRUTH WHEREOF, I have hereunto set my hand this January 10, 2019 at
Laoag City, Philippines.

NIDA CU ARELLANO
Affiant

SUBSCRIBED AND SWORN to before me this January 10, 2019 at Laoag City,
Philippines.

ATTY. JASON BADER LL. PERERA

Notary Public
Doc. No.______; Until December 31, 2019
Page No.______; Roll of Attorney’s No. 54820
Book No. 285; IBP No. 0990814-I.N.-12/05/2017
Series of 2018. PTR NO.1766978-L.C.-01/03/2019