REPUBLIC OF THE PHILIPPINES }

TABUK CITY, KALINGA } SS.

AFFIDAVIT OF LOSS
I, Juan de Cruz JR., of legal age, married, Filipino and a resident of Quezon,
Isabela after having been sworn in accordance with law hereby depose and state:

1. That I am driver of Motor Vehicle under the name of Juan de Cruz JR;

2. That I a a holder of a TEMPORARY OPERATIORS PERMIT No.

16122569 (TOP), which was duly issued by the Land Transportation Office
(LTO), Tabuk City, Kalinga

3. That sometime on the month of July, 2019, when I tried to redeem the said
TOP at Land Transportation Office, Tabuk City, Kalinga, the staff of said
office had been looking for the copy of the Temporary Operators Permit but
when I tried to locate the same in my wallet which I vividly recall to have kept
it for safekeeping, I was surprise to know that the same was no longer be
found in my wallet. ;

4. That despite diligent search and efforts to locate the said passport I could not
find it such that I now believe that it is now lost beyond recovery;

5. That I am executing this Affidavit of Loss to attest to the truth of the foregoing
allegations and for all legal intents and purpose that it may be serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 23nd

day of August 2019 in Tabuk City, Kalinga.

Juan de Cruz JR
Affiant

SUBSCRIBED AND SWORN to before me this 22nd day of August, 2019 at

Tabuk City, Kalinga affiant exhibiting to me her competent evidence of identity
by way of his UMID I.D No. 0111-5521617-5.

NOTARY PUBLIC

Doc. No._____
Page No._____
Book No._____
Series of 2019.