REPUBLIC OF THE PHILIPPINES)

CITY OF MANILA ) S.S.

x----------------------------x

AFFIDAVIT OF LOSS

I, Pablo Jan Marc A. Filio IV, of legal age, Filipino, single, and
residing at 19 Manalo Street Veterans Village Project 7, Quezon 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 999-
100-888-45 which is valid until April 25, 2018;

2. Sometime on January 25, 2017 around 9:00 PM, the said driver's
license was stolen when somebody robbed my bag with force and
stealth while I was crossing at the corner of Taft Avenue and Nakpil
Street on my way to De La Salle University. The lost driver’s license
was inside my wallet which was kept inside the bag. Together with
the stolen bag, the wallet and the driver’s license were also stolen.

3. Efforts were exerted to locate the said driver's license, but in spite
of diligent search, it could not be found and the same is now beyond
recovery. I tried to run after the robber to get my bag back but with no
avail. The traffic enforcer tried to run after the robber but was able to
escape from them. I went to barangay hall of Barangay 686 to report
the incident. Unfortunately, the (Close Circuit Television) CCTV
Camera installed at corner of Taft Avenue and Nakpil Street was not
functioning during that day when the incident happened. I filed a
barangay blotter report about the robbery incident and also Police
blotter report signed by SPO1 Juan De La Cruz with report No.
5678910. Unfortunately, I was not able to identify the culprit from the
pictures shown by the police officer because I was not able to identify
the robber.

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;

PABLO JAN MARC A. FILIO IV

Affiant

SUBCRIBED AND SWORN TO before me this February 15, 2017 in

Salud and Sales Law Office Manila, Philippines, affiant exhibiting to
me his/her competent evidence of identity by way of Social Security
Service Identification (SSS ID) 0034-0787831-1 issued at SSS
Building East Avenue, Quezon City on March 30, 2006.

Doc. No. _____;

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