REPUBLIC OF THE PHILIPPINES )

Province of Negros Oriental )

City of Dumaguete )S.S.
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AFFIDAVIT OF LOSS

I, GRACELYN BELLINGAN-BENNETT, of legal age, Filipino, married and a

resident of Dumaguete City, Negros Oriental, after having been sworn in
accordance with law, hereby deposes and states the following that:

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

Transportation laws, rules and regulations, and was issued a Driver's
License at LTO Bais City last May 31, 2018. Attached hereto is a scanned
copy of my driver’s licence which I was able to take after it was issued;

2. That I have placed the said license in a small pouch together with my
other IDs;

3. However, sometime last weekend, when I was in Cebu City, I discovered

that my small pouch was no longer in my bag. I suspect it might have fell
off during my travel.

4. That despite diligent search and efforts to locate my pouch with my ID, I
could not find the same such that I now believe that it is now lost beyond
recovery;

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

6. 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 and for whatever legal purposes this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 28TH day of

September 2018 at Dumaguete City, Philippines.

GRACELYN BELLINGAN-BENNETT

SUBCRIBED AND SWORN TO before me this 28th day of September 2018

in Dumaguete City, Philippines, affiant personally known to me to be the person
who executed and signed this affidavit.

WITNESS MY HAND AND SEAL.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2018.