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Republic of the Philippines)

Olongapo City .) S.S.

AFFIDAVIT OF LOSS
I, PEDRO R. SANTIAGO,

of legal age, Filipino, presently residing

Manila Avenue Subic Bay Freeport Zone,

at 1820

Philippines, after having duly sworn to in

accordance with law, hereby depose and state, that:


1.

That I applied for a Drivers License and was issued a Temporary


Drivers License by Land Transportation Office, Olongapo City;

2.

That last November, when I went home, I inspected my personal things,


and there I noticed that my temporary drivers license was already
missing;

3.

Despite diligent effort to locate the same, all efforts proved fruitless, and I
surmised that the said Temporary Drivers License was lost somewhere,
and up to the present, fear that the same has been lost beyond recovery;
and

4.

I am executing this affidavit of loss to attest to the truth of the foregoing, to


request for the replacement/re-issuance of my lost Temporary Drivers
License and for whatever legal purpose it may serve.

AFFIANT FURTHER SAYETH NAUGHT.


IN WITNESS WHEREOF, I have hereunto affix my signature this 9th day of
December 2015 at Subic Bay Freeport Zone, Olongapo City, Philippines.

PEDRO R. SANTIAGO
- Affiant -

SUBSCRIBED AND SWORN to before me this 9th day of December 2015 at


Subic Bay Freeport Zone. Affiant exhibited to me his Community Tax Certificate No. CC
01857714 as proof of his Personal Identification

Doc No.: 492;


Page No. 100;
Book No.
XI;
Series of 2015.