REPUBLIC OF THE PHILIPPINES)

CITY OF BUTUAN
) S.S.
x----------------------------x
AFFIDAVIT OF LOSS
I, PHILIP BRENT M. CARIAGA, of legal age, Filipino, (single/married/widow)
and a resident of P-2B BONBON, BUTUAN CITY, after having been duly
sworn
to
in
accordance
with
law,
depose
and
state THAT:
1. I am a duly-licensed driver in accordance with pertinent Land Transportation
laws, rules and regulations, and was issued a corresponding (Non)
Professional Driver's License with number _____________ which is valid
until _____________;
2. Sometime on October 4, 2016, said driver's license was misplaced and got
lost;
3. Efforts were exerted to locate said driver's license, but in spite of diligent
search, it could not be found and the same is now beyond recovery;
4. Said Driver's License has not been confiscated by the LTO, Police or other
Traffic Enforcers for any traffic violation;
5. 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 Non
Professional Driver's License, in lieu of the one that was lost;
IN WITNESS WHEREOF, I have hereunto set my hand this October 6,
2016 in Butuan City, Philippines.

SUBCRIBED AND SWORN TO before me this _August 6, 2016 in

__Butuan City_, Philippines, affiant exhibiting to me his/her competent
evidence of identity by way of School Id No. 14200001946 issued at
__Butuan City__ valid until __May 2017__.
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2013.