REPUBLIC THE PHILIPPINES)

BATANGAS CITY ) S.S.

AFFIDAVIT OF LOSS

I, JOSEPH REUBEN ARGUELLES GOOL, single, of legal age, Filipino,

and a resident of Sampaga Greenhills, Gov. Antonio Carpio Rd., Sampaga,
Batangas City, after having been duly sworn to in accordance with law, hereby,
depose, and state that:

[1] I am a holder of a temporary Non-Professional Driver’s License,

issued by the Land Transportation Office (LTO);

[2] Recently, while I was searching for the said Driver’s License, I have
discovered that the same was lost;

[3] I exerted diligent efforts to find and locate the said item but the
same proved futile;

[4] Moreover, the said item was not confiscated nor made subject of
apprehension by any government authority;

[5] Furthermore, said item has not been returned to me;

[6] I am executing this affidavit to attest to the truth and to inform the
proper authorities of all the foregoing facts, and for whatever legal purpose this
Affidavit may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 04 July

2018, at Batangas City.

JOSEPH REUBEN ARGUELLES GOOL

Affiant
ID No.

SUBSCRIBED AND SWORN TO BEFORE ME this 04 July 2018, at

Batangas City, affiant exhibited to me his Identification Card with number stated
above.

SONNY JOSE M. RICABLANCA

Notary Public
Until 31 December 2018
PTR No. 3022119 01-03-18 Batangas City
Doc. No. ____; IBP No. 1065629 Batangas City
Page No. ____; Roll No. 69544 Serial No. 2017-20
Book No. ____; MCLE Exempted, pursuant to MCLE Governing
Series of 2018. Board Order No. 1, S.2008
Zenaida Arcade, 43 M.H. del Pilar St., Batangas City

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Affidavit of Loss