REPUBLIC OF THE PHILIPPINES )

Province of Leyte ) S.S.

Municipality of Villaba )
x--------------------------x

AFFIDAVIT OF LOSS

I, EDRED CARY MONARES ROSAROSO, Filipino, of legal age, single, and with
residence at 7-Villa Abuno St., Mc-Arthur Blvd., Cebu City, Philippines, after being duly
sworn to in accordance with law, hereby depose and state:

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

Transportation laws, rules and regulations, and was issued a corresponding
Driver's License with number G0610S04504 which is valid until 05/18/2011
(Drivers License was first issued on 05/18/2010);

2 That sometime on the year 2010, said Driver's License was misplaced and got
lost;

3 That despite diligent search and efforts to locate my Driver's License, I could not
find the same such that I now believe that it is now lost beyond recovery;

4 That said Driver's 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 Driver's
License, in lieu of the one that was lost.

IN WITNESS WHEREOF, I have hereunto set my hand this 19 th day of January 2017
at Villaba, Leyte, Philippines.

EDRED CARY MONARES ROSAROSO

AFFIANT

SUBSCRIBED AND SWORN to before me, this 19 th day of January 2017 at Villaba,
Leyte, Philippines, by the Affiant who is personally known to me (or whom I have identified
through competent evidence of identity) and who exhibited his Employers Identification Card
No. RCS-803 issued at Cebu City, Philippines.

NOTARY PUBLIC

Doc. No. ______;

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