REPUBLIC OF THE PILIPPINES)

PROVINCE OF CAGAYAN )S.S.

TUGUEGARAO CITY
)
x---------------------------- x

AFFIDAVIT OF LOSS
I, ____________________________, of legal age, single, Filipino and
resident of _________________________, Tuguegarao City, Cagayan, after
having been sworn to in accordance with law hereby depose and state:
1. That just recently while boarding a tricycle I noticed that my
wallet containing several documents including my PROFESSIONAL
DRIVERS LICENSE was missing;
2.That I tried to locate the said wallet including my DRIVERS
LICENSE but I can no longer find it;
3. That upon verification and diligent search said DRIVERS
LICENSE was discovered to have been lost and now beyond recovery;
4. That I am executing this affidavit to attest to the veracity of
the above statements.
Affiant Sayeth Naught.
WITNESS MY HAND, this _____ day of March 2006.
Tuguegarao City.

__________________________
Affiant
SUBSCRIBED AND SWORN TO BEFORE ME, this ____ day
of March 2006. Tuguegarao City.

Notary Public
Doc. No. ____
Page No. ____
Book No. ___
Series of 2015.