REPUBLIC OF THE PHILIPPINES ) Province of Zamboanga del Sur ) S.S.

City of Pagadian ) x-----------------------x

AFFIDAVIT OF LOSS I, DAVE LUMASAG CANUMHAY, Filipino, of legal age, single, and a resident of San Francisco District, Pagadian City, Philippines, after being duly sworn to in accordance with law, hereby depose and state:

1. That I am a duly-licensed driver in accordance with pertinent Land Transportation laws, rules and regulations, and was issued a corresponding Driver's License which is valid until May 8, 2015, and at the same time the registered owner of a certain motor vehicle, which is more particularly described as follows:

Make Series

: :

HONDA ANF100MSPJ MOTORCYCLE 0920-00000049000 KWY10034025 2009 BLACK 8803 JG

Type of Body: MV FILE No. : Chassis No. : Yr. Model Color Plate No. : : :

2. That on September 30, 2013 at around 9:30 in the morning, while I was in Santiago District to fetch my auntie at the Markets dried fish section, I lost my wallet which I usually place in my back pocket;

3. That inside the said wallet are my Driver's License, Official Receipt (OR) and Certificate of Registration (CR) of my motorcycle, School ID, and ATM Card issued by Banco De Oro, Pagadian Branch;

4. That despite diligent search and efforts to locate the said wallet and my Driver's License, Original Official Receipt (OR) and Certificate of Registration (CR) of my motorcycle, School ID, and ATM Card, I could not find them such that I now believe that they are now lost beyond recovery;

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

6. 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, Official Receipt (OR) and Certificate of Registration (CR) of my motorcycle, School ID, and ATM Card, in lieu of the ones that were lost.

IN WITNESS WHEREOF, I have hereunto set my hand this October 8, 2013 at Pagadian City, Philippines.

DAVE LUMASAG CANUMHAY AFFIANT

SUBSCRIBED AND SWORN to before me, this October 8, 2013, by the Affiant who is personally known to me and who exhibited his Social Security System (SSS) Identication with No. 34-1286637-6.

NOTARY PUBLIC

Doc. No. ______; Page No. ______; Book No.______; Series of 20____.