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Republic of the Philippines )

DONE: CITY OF BAGUIO ) SS.

AFFIDAVIT OF LOSS

I, SANTIAGO MASCULINO, of legal age, married, Filipino Citizen with residence


and postal address at 78 Purok 5, Pucsuan, Baguio City after having been duly sworn to
in accordance with law do hereby depose and state that:

1. I was issued a Drivers License by the Land Transportation Office (LTO);

2. Sometime on 2015, I was involved in a vehicular accident and my Drivers


License was taken by the Investigating Policemen assigned at Police Station
10;

3. When I went to claim my Drivers License at the Land Transportation Office


(LTO), my said Drivers License could not be located and maybe explained
that the apprehending Policemen was already deceased;

4. I am executing this affidavit to attest to the truth of my foregoing statements


and for purposes of securing new Drivers License in lieu of the lost one and
for all legal intents and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 1st day of June 2017,
at Baguio City, Philippines.

SANTIAGO MASCULINO
Affiant

SUBSCRIBED AND SWORN TO before me this 1st day of June 2017 at Baguio
City, Philippines. Affiant personally appeared before me and known to me personally
known to me to be the same person who executed this instrument freely and willingly.

MODESTO T. ANDONG
Notary Public
Commission No. 35-NC-16-R/Until: December 31, 2017
PTR No. 2945281/01-05-2017/Baguio City
IBP No. 1056844/01-05-2017
Baguio-Benguet Chapter
Roll No. 31289/5-15-81/Manila
MCLE COMPLIANCE No. VI-0000192/June 14, 2016
BIR TIN No. 121-017-652-000
No. 19, 2nd Floor Old Market Bldg.,
Magsaysay Ave., Baguio City, Philippines
Doc. No. 244;
Page No. 49;
Book No. XXIII;
Series of 2017.