REPUBLIC OF THE PHILIPPINES )

______________________________) S.S.

AFFIDAVIT OF LOSS

KNOW ALL MEN BY THESE PRESENTS:

I, MARIA LUISA SUYO GALANG of legal age, Filipino, single, and a resident of #4
Mercury St. Pacita 2 San Pedro, Laguna , after having been sworn in accordance with law,
hereby depose and state the following:

1. I am holder of the Driver’s License with serial number G01-05-008877 issued by

the Land Transportation Office;

2. That I placed the said Driver’s License inside my wallet;

3. That on 21 January 2018, while my family and I were attending mass, the window
of my car was smashed and destroyed by an unknown thief and stole items
therein;

4. That said thief took with him, among others, my wallet which contains my
Driver’s License;

5. That due to the incident, my Driver’s License is now believed to be lost beyond
recovery;

6. That my Driver's License has not been confiscated by the LTO, Police or other
Traffic Enforcers for any traffic violation;

7. 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.

MARIA LUISA SUYO GALANG

AFFIANT

SUBSCRIBED and SWORN to before me this 2nd day of January 2018 at

________________ affiant exhibiting before me her Passport as identification with number
EC2988735 and valid until 15 December 2019 known to me and to be known to be the same
person who executed the foregoing instrument which she acknowledged to be her free act and
deed.

NOTARY PUBLIC
Doc. No. _______;
Page No. _______;
Book. No. _______;
Series of 2018.