Republic of the Philippines )

City of Cagayan de Oro ) ss.

AFFIDAVIT OF LOSS

I, MARK ANTHONY S. RAMOS, Filipino, of legal age, single, and a resident of Gasi,
Laguindingan, Misamis Oriental, Philippines, after being duly sworn to in accordance with law,
hereby depose and state:

That on July 26, 2018 in the evening while I was at Gitagum, Misamis Oriental, I lost my
wallet which I usually place in my back pocket.

That inside the said wallet are my Driver's License, Motorvehicle’s Certificate of
Registration and Original Receipt, SSS ID, Voter’s ID and Intellicare Card issued by my
employer;

That despite diligent search and efforts to locate the said wallet and my Driver's License,
Motorvehicle’s Certificate of Registration and Original Receipt, SSS ID, Voter’s ID and Intellicare
Card, I could not find them such that I now believe that they are now lost beyond recovery

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

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 a new ATM Card, in
lieu of the ones that were lost.

IN WITNESS WHEREOF, I have hereunto set my hand this 30th day of July, 2018 at
Cagayan de Oro City.

MARK ANTHONY S. RAMOS

Affiant

SUBCRIBED AND SWORN TO before me this 30th day of July, 2018 in Cagayan de
Oro City, Philippines, affiant exhibiting to me her competent evidence of identity.

Page No. _19__;

Page No. __4__;
Book No. _II__;
Series of 2018