Republic of the Philippines }

CITY OF DIGOS } ss.

x- - - - - - - - - - - - - - - - - - x

AFFIDAVIT OF LOSS

I, ARYA STARK, of legal age, Filipino, single and a resident of

Purok Madasigon, Sta. Ana, Tres de Mayo, Digos City, Davao del Sur
after having been sworn to in accordance with law, do hereby 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 Professionals Driver License with number
D12-45-321916 which is valid until September 2019;

2. Sometime in March 2017, said Drivers License was

misplaced and lost;

3. Efforts were exerted to locate said drivers license, but in

spite of diligent search, it could not be found and the same is
now beyond recovery;

4. Said Drivers 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 Drivers License, in lieu of the one that
was lost.

IN WITNESS WHEREOF, I have hereunto set my hand this 16 th

day of June 2017 in Digos City, Philippines.

ARYA STARK
Affiant
Voters ID VIN: 2319-0492A-C0390ASL20000
 SUBSCRIBED AND SWORN to before me this this 16th day of
June 2017 in Digos City, Philippines, Affiant exhibiting to me her valid
identification document indicated below her name.

Notary Public

Doc. No. _____;

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