Republic of the Philippines)

Province of Quirino) S.S.

Municipality of Diffun)
x-----------x

AFFIDAVIT OF LOSS DRIVER’S LICENSE

I, KARL T. DE GUZMAN, of legal age, single ,Filipino and a

resident of Andres Bonifacio, Diffun, Quirino, having been duly sworn
in accordance with law, hereby depose and state:
1. That I am the owner of the DRIVER’S LICENSE;
2. That sometime on April 16, 2018, I noticed that the said
Driver’s License was missing;
3. That to my knowledge, my DRIVER’S LICENSE was lost;
4. That I took great pains to look for the said DRIVER’S LICENSE
but no avail;
5. As such, I am executing this affidavit to attest to the foregoing
facts and to support the application for the issuance of a new one
in lieu of the one which was lost.
IN WITNESS WHEREOF, I have hereunto set my hand this 25th day
of April 2018, at Diffun, Quirino, Philippines.

KARL T. DE GUZMAN
Affiant
ID NO.B07-15-000664
SUBSCRIBED and SWORN to before me on the date and at the
place indicated below. The affiant exhibited to me his competent
evidence of identity as indicated above.

Signed this 25th day of April 2018 at Diffun, Quirino.

WITNESS MY HAND AND SEAL.