Republic of the Philippines)

Province of Masbate ) S.S.

City of Masbate )

AFFIDAVIT OF LOSS

I, Aldren Cleofe Libot, of legal age, Filipino and a resident of 106

Quirino St.Brgy. Poblacion, Baleno, Masbate, after having been duly sworn to
in accordance with law, hereby depose and say:

1. That I am the owner of drivers license no. N2605014667 with official

receipt no. 1124819813 issued on May 02, 2017 duly issued by the
Land Transportation Office ( LTO);

2. That recently, I noticed that my license receipt was missing, efforts to

locate in vain, and for all intents and purposes considered lost or
stolen;

3. That I wish to manifest that said drivers license receipt was not given
or endorsed to anybody but simply lost or stolen;

4. That I have executed this affidavit to attest to the truth of all the
foregoing and satisfy the inquiry or requirements of any person or
office particularly the LTO and for other legal purpose.

IN WITNESS WHEREOF, I have hereunto set my hands this 6th..DAY OF

OCTOBER 2017 in the City of Masbate, Philippines.

ALDREN CLEOFE LIBOT

Affiant

JURAT

SUBSCRIBED AND SWORN to before me this 6TH. DAY OF OCTOBER,2017

at Masbate City AFFIANT exhibiting to me as proof of his identity his PRC
License Card with No. 0015398.

Doc. No. _______;

Page No. _______;
Book No. II;
Series of 2017;