Republic of the Philippines )

City of Cagayan de Oro ) S.S.

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AFFIDAVIT OF LOSS

I, PHILLIP E. LACABA III, Filipino, of legal age, married and a resident of Zone 4
Kauswagan, Cagayan de Oro City, Philippines, after being duly sworn to in accordance with
law, hereby depose and state:

1. That a Professional Drive’s License was issued under my name which will expire on
September 30, 2018;

2. That on the evening of November 30, 2017 at around 10:30 PM, I lost my wallet which
I usually place in my back pocket;

3. That inside it was my Driver's License;

4. That despite diligent search and efforts to locate the said wallet and its contents, I could
not find them such that I now believe that they are already 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.

As such, I am executing this Affidavit of Loss to attest to the foregoing and for whatever legal
purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this_____________ in Cagayan de

Oro City, Philippines.

PHILLIP E. LACABA III

Affiant

SUBSCRIBED AND SWORN TO before me this ________________at Cagayan de Oro City,

Philippines.

Notary Public

Doc. No. ____;

Page No.____;
Book No.____;
Series of 2017.