I, ADRIANO C. BAGSIT III, married of legal age, Filipino,
and a resident of Batangas City, after having been duly sworn to in accordance with law, hereby, depose, and state that:
[1] I am a holder of a 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 05 November 2018, at Batangas City.
ADRIANO C. BAGSIT III
Affiant ID No.____________________________
SUBSCRIBED AND SWORN TO BEFORE ME this 05
November 2018, at Batangas City, affiant/s exhibited to me his/her/their Identification Card with number stated above.
SONNY JOSE M. RICABLANCA
Notary Public Until 31 December 2018 PTR No. 3022119 01-03-18 Batangas City IBP Lifetime No. 019079 Doc. No. 411 Roll No. 69544 Serial No. 2017-20 Page No. 84 MCLE Exempted,SONNYpursuant to MCLE JOSE M. RICABLANCA Book No. XIII Notary Public Governing Board Order No. 1, S.2008 Series of 2018. Until 31 December 2019 Zenaida Arcade, PTR43No.M.H. del 3022119 PilarBatangas 01-03-18 St., City Batangas City IBP No. 1065629 Batangas City Roll No. 69544 Serial No. 2017-20 MCLE Exempted, pursuant Pageto1MCLE of 2 Governing Board Order No. 1, S.2008 Affidavit of Loss Zenaida Arcade, 43 M.H. del Pilar St., Batangas City Page 2 of 2 Affidavit of Loss