Republic of the Philippines

Camiling, Tarlac

)
) S.S

AFFIDAVIT OF LOSS
I, ROGER IBALE IDOS, 23 years old, Filipino citizen, single and a resident of
Barangay Bilad, Camiling, Tarlac, Philippines, after having been duly sworn to in accordance
with law, do hereby depose and state THAT:
1. I am a holder of a Professional Drivers License, the number of which I could no
longer recall, issued by the Land Transportation Office, Philippines;
2. I have been keeping the said license in my wallet which, in turn, I usually keep
inside my pocket every time I drive my tricycle;
3. My wallet contained my Professional Drivers License, some cash and other
personal belongings;
4. On March 18, 2015, on or about 6:30PM, I drove my tricycle from Purok 2 of
Barangay Bilad, Camiling, Tarlac going to Purok 3 of the same barangay to
transport some passengers;
5. Upon reaching our destination, I discovered that my wallet was missing from my
pocket. I immediately searched my wallet in my tricycle but I found nothing. Also, I
went back along the way to search for my wallet but I did not find it;
6. The said incident was reported to the Camiling Police Station, Camiling, Tarlac;
7. Diligent efforts were exerted to locate my wallet containing my professional drivers
license proved futile; hence, I now consider the same as lost and beyond recovery;
8. My license was never confiscated by any authority nor pledged to secure any
obligation;
9. I am executing this affidavit to attest to the truth of the foregoing statements and
for all legal purposes and intents this may serve.
IN WITNESS WHEREOF, I have hereunto affixed my signature this 20 th day of March,
2015 at Camiling, Tarlac, Philippines.
ROGER I. IDOS
Affiant
SUBSCRIBED AND SWORN to before me on the date and place indicated above.
Affiant exhibited to me his Voter ID with VIN: 6903-0032A-I249RII10000 issued by the
COMELEC, Camiling, Tarlac.