AFFIDAVIT OF LOSS

I, Naruto Uzumaki, of legal age, Filipino, single and a resident of Cordon, Isabela,
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 (Non) Professional
Driver's License with number B1207890076 which is valid until July 17, 2022;

2. Sometime on December 26, 2017, said driver's license was misplaced and got
lost;

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

4. 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 (Non) Professional
Driver's License, in lieu of the one that was lost;

IN WITNESS WHEREOF, I have hereunto set my hand this 10th Day of

January 2018 in Santiago City, Philippines.

Naruto Uzumako
Affiant

SSS ID No. 454657865

SUBCRIBED AND SWORN TO before me this 10th Day of January 2018 in Santiago
City, Philippines, affiant exhibiting to me his/her competent evidence of identity by way
of SSS ID issued at Santiago City on November 10, 2017.

Doc. No. 13;

Page No. 17;

Book No. 12;

Series of 2018.