REPUBLIC OF THE PHILIPPINES)

Municipality of Ipil)
Zamboanga Sibugay ) S.S.
x----------------------------x

AFFIDAVIT OF LOSS

I, Isidro M. Pioc, of legal age, Filipino, married and a resident of Poblacion

Ipil, ZSP, after having been duly sworn to in accordance with law, depose
and state THAT:

1. I am a duly-licensed driver in accordance with pertinent Land Transportation

laws, rules and regulations, and was issued a corresponding Drivers license;
said was misplaced and got lost;

3. Efforts were exerted to locate said License, but in spite of diligent search, it
could not be found and the same is now beyond recovery;

4. Said License has not been confiscated by the LTO, Police or other
Traffic Enforcers for any traffic violation;

5. 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 License,
in lieu of the one that was lost;

IN WITNESS WHEREOF, I have hereunto set my hand this 29th of

May, 2017 in Ipil, Zamboanga Sibugay, Philippines.

Isidro M. Pioc
AFFIANT

SUBCRIBED AND SWORN TO before me this 1st day of June in

Ipil,Zamboanga Sibugay, Philippines.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2017.