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REPUBLIC OF THE PHILIPPINES )

City of Manila ) S.S.


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

AFFIDAVIT OF LOSS

I, CATALINO A. MAGAT, JR., of legal age, Filipino Citizen, and a resident


of 173 Garcia St., Malacañang Village, Sucat, Parañaque City, after having been
duly sworn in accordance with law, hereby depose and say that:

1. I have been issued a Driver’s License last January 5, 2017;


2. On December 23, 2017 at about 7 pm, when I left the premises in a
restaurant in MOA after dining in, I also left my wallet where my
Driver’s License is inserted.
3. A few minutes after noticing that my wallet is not with me, I returned
to the said restaurant and inquired to the security guard and waiters-
in-charge if they have seen a wallet in the spot where I was seated;
4. I failed to recover my wallet as well all of my identification cards (ID)
including my driver’s license despite diligent search and efforts and I
consider the same as lost and can no longer be found;
5. I am executing this Affidavit to attest to the truth of the foregoing facts
and in support of my application for the replacement of my lost driver’s
license and for whatever legal intents and purposes it may serve.

Affiant states nothing further.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ______


day of _____ __________ in _________________, Philippines.

CATALINO A. MAGAT, JR
Affiant

SUBSCRIBED AND SWORN TO before me this ______ day of ________ 2018


in _______________, Philippines, affiant exhibited his ___________________________
valid until JULY 24, 2021.

Doc. No._____;
Page No._____;
Book No._____;
Series of 2019.

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