REPUBLIC OF THE PHILIPPINES)

CITY OF ILIGAN . . . . . . . . . . .)S.S.

x - - - - - - - - - - - - - - - - - - -/

AFFIDAVIT OF LOSS
I, LEOLANDO V. ECHAVEZ, of legal age, Filipino, married and a
resident of Purok 3- Barangay Santiago, Iligan City, Philippines, after being
duly sworn to an oath, in accordance with law, hereby deposes and states,
that:
1 I am a holder of a Drivers License issued at Land Transportation Office
Iligan City with no. NO491192969;
2 I placed the said Drivers License in my wallet;
3 However, last week, when I was traveling from Cagayan de Oro City to
Iligan City, I noticed that the said wallet where I placed my Drivers
License was lost;
4 Despite diligent search and effort to locate the said wallet, I could not
find it and thus considered the Drivers License lost for all intents and
purposes;
5 As such, I am executing this affidavit to attest to the truth of the
foregoing and for whatever legal purposes this may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this 24th day of
July 2015 at Iligan City, Philippines.

LEOLANDO V. ECHAVEZ
Affiant

SUBSCRIBED AND SWORN to before me this 24th day of July 2015, in

the City of Iligan, Philippines.

Doc. No. 38;

Page No. 08;
Book No. IX;
Series of 2015.

THOMAS DEAN M. QUIJANO

Notary Public
Until December 2015
PTR No. 6049685 / 01-15-15 / Iligan City
IBP No. 944390 / 01-13-15 / Iligan City
Attorneys Roll No. 36882 1991