REPUBLIC OF THE PHILIPPINES)

CITY OF PAGADIAN ………………) S.S.

X===================/

AFFIDAVIT OF LOSS

I, MOISES LOMOCSO RACHO, of legal age, married, Filipino with present postal address
at Purok Gugma, Lluch Street, Ballesteros Village, Balangasan District, Pagadian City, after
having been duly sworn to in accordance with law, do hereby depose and say:

1. That I am a driver by occupation having been issued Professional Driver’s License No.
K04-01-033680 with expiry date: March 12, 2004;

2. That, however, before the expiry of my said driver’s license, I was also engaged in
farming for a considerable length of time even up to the present, and by reason of my non-use
of my said driver’s license, the same was inadvertently misplaced among my personal files I
kept in my parent’s house in Ozamiz City;

3. That in spite of diligent efforts I exerted to locate the exact place where I last stored
it, my said driver’s license nevertheless could no longer be traced and any attempt on my part
with the help of the immediate members of my family to locate its whereabouts, the same
proved futile and to no avail; as a consequence thereof, I treat my Professional Driver’s License
No. K04-01-033680 with expiry date: March 12, 2004, as having been lost forever beyond
discovery.

4. That I have executed this affidavit of loss to establish the veracity and truthfulness of
the foregoing facts for all legal intents and purposes, and in connection with my present
application for renewal of my driver’s license.

IN WITNESS WHEREOF, I have hereunto set my hand and affixed my signature this 29 th
day of February, 2012, at Pagadian City, Philippines.

MOISES LOMOCSO RACHO

Affiant

SUBSCRIBED AND SWORN to before me this 29th day of February, 2012, at Pagadian City,
Philippines, the affiant exhibited to me his Community Tax Certificate for the current year
2012.

Doc. No. _____;

Page No. _____;
Book No. _____;
SERIES OF 2012.