REPUBLIC OF THE PHILIPPINES) City of Zamboanga ) S.S. x-----------------------x AFFIDAVIT OF LOSS I, WILFREDO FRANCISCO JR.

y DEL ROSARIO, Filipino, of legal age, married, and a resident of Bulahan Drive, San Jose, Philippines, after being duly sworn to in accordance with law, hereby depose and state: That I am an employee of Western Mindanao State University and at the same time a duly-licensed driver; That in the afternoon of August 27, 2012 I lost my wallet which I usually place in my back pocket; That inside the said wallet are my Driver's License, SSS ID, and WMSUEmployee ID; That despite diligent search and efforts to locate the said wallet and my Driver's License, SSS ID, and WMSU-Employee ID, I could not find them such that I now believe that they are now lost beyond recovery; That my Driver's License has not been confiscated by the LTO, Police or other Traffic Enforcers for any traffic violation; As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing and to support my application for the issuance of a new Driver's License, SSS ID, and WMSU-Employee ID, in lieu of the ones that were lost. IN WITNESS WHEREOF, I have hereunto set my hand this _____________ at _____________, Philippines.

WILFREDO FRANCISCO JR. Affiant

SUBSRIBED AND SWORN Zamboanga City, Philippines.

to

before

me

this

____________________

at

NOTARY PUBLIC

Doc. No. ______; Page No. ______; Book No.______; Series of 2012.