REPUBLIC OF THE PHILIPPINES}

DONE: IN THE CITY OF BAGUIO } S.S.

x ------------------------------------------- x

AFFIDAVIT OF LOSS

I, A., of legal age, Filipino citizen, and a resident of #120 Slaughter Compound, Baguio
City, after having been duly sworn to in accordance with law, do hereby depose and say that:

1. I was issued by the Land Transportation Office issued by LTO – Baguio City a
non-professional Driver’s License last September 2015;

2. I have kept the said non-professional Driver’s License with me every where I go;

3. Last August 13, 2018, I presented my non-professional Driver’s License before

the Security of Sandiganbayan as proof of my identify before proceeding to the
office to which I have an official business with.

4. After concluding my business with Sandiganbayan, I then secured my non-

professional Driver’s License before leaving.

5. I then placed my non-professional Driver’s License inside my pocket and

travelled back to Baguio.

6. However, I only noticed that my non-professional Driver’s License was already

missing upon arriving at Baguio. I then searched the bus and asked the
conductor if he noticed my non-professional Driver’s License.

7. Despite diligent efforts I exerted to recover the said non-professional Driver’s

License the same proved futile and fruitless hence I considered it lost and
beyond point of recovery;

8. The abovementioned non-professional Driver’s License was neither confiscated

for any violation of any laws, rules or regulations nor was it delivered to any
person to guaranty the performance of any obligation;

9. I am now executing this affidavit to attest to the veracity of the foregoing

narration for securing a replacement of the said lost non-professional Driver’s
License and for all legal intents and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 15th day of August 2018 in
the City of Baguio, Philippines.

_____________________
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SUBSCRIBED AND SWORN to before me, in the City of Baguio, Philippines, this
15th day of August 2018, ., who is personally known to me and who is the same person who
personally signed before me the foregoing affidavit and acknowledged that he executed the
same.

Doc. No. 74;

Page No. 15;
Book No. II;
Series of 2018.