AFFIDAVIT OF LOSS

I, Abelardo C. Otadoy, of legal age, Filipino, and a resident of Pulot, Taysan, Albay,
after having been duly sworn in accordance with law, hereby depose and state that:
1. I have a Professional Drivers License ID and the original Certificate of
Registration of a motor vehicle with Plate No. 2044EI, issued by the Land Transportation Office
Legazpi, Albay.
2. I used to place the aforesaid drivers license ID and the certificate of registration in my
wallet which I carried in my back pocket.
3. However, Last night, October 10, 2013, while I was driving on my way home, I didnt
notice that my wallet including its contents was missing.
4. That despite my diligent efforts to locate said wallet including its content, the same
could no longer be found.
5. Thus, my license ID and certificate of registration is now considered lost.
6. That I am executing this affidavit for the purpose of complying with the requirements
of the Land Transportation Office for the issuance of a replacement license ID and Certificate of
Registration.
IN WITNESS WHEREOF, I have hereunto set my hand this 10th day of October 2013 at
Legazpi City, Philippines.

Abelardo C. Otadoy
Affiant

SUBSCRIBED AND SWORN to before me, in Legazpi City, Philippines, this 11th day of
October 2013, by Abelardo C. Otadoy, who is known to me personally.

Doc. No. 221

Page No. 46
Book No. 01
Series of 2013.

LUIS D. MAGISTRADO
NOTARY PUBLIC
Until December 2014
App. No. 2013-05
Roll No. 56241
PTR No. 096700 dtd. Jan. 2, 2013
IBP No. 90131120 dtd. Jan. 2, 2013
MCLE COMPLIANCE No. IV-0007824
12 September 2012