REPUBLIC OF THE PHILIPPINES)

CALOOCAN CITY )S.S.

Affidavit of Loss

I, LORNA A. REAL, of legal age, Filipino, married with residence

at 22D Palawan Alley, Macaneneng Street, Brgy. 153 Bagong
Barrio, Caloocan City, after having been duly sworn in accordance
with law, depose and state that:

1. I am a holder of Non-Professional Driver’s License issued by

Land Transportation Office (LTO);

2. Sometime last December 2018, while I was on my way home

to Bagong Barrio, Caloocan City, I notice that my bag
containing the said passbook was no longer in my
possession;

3. Despite diligent efforts, I could not locate the same and I

presumed it to be lost already;

4. I executed this affidavit to explain the loss of my Driver’s

License and for whatever purpose this may serve.

In witness whereof, I signed this affidavit on this _____ day of

___________ 2019 in Caloocan City.

LORNA A. REAL
Affiant

Subscribed and sworn to before me on this ____ day of

_________ 2019 in Caloocan City. Affiant exhibiting to me her SSS
ID no. 03-7512766-3

Doc. No. ____

Page No. ____
Book No. ____
Series of 2019.
REPUBLIC OF THE PHILIPPINES)
CALOOCAN CITY )S.S.

Affidavit of Loss

I, LORNA A. REAL, of legal age, Filipino, married with residence

at 22D Palawan Alley, Macaneneng Street, Brgy. 153 Bagong
Barrio, Caloocan City, after having been duly sworn in accordance
with law, depose and state that:

1. I am a holder of Joint account Passbook with my son,

RICHARD A. REAL issued by Metrobank;

2. Sometime last December 2018, while I was on my way home

to Bagong Barrio, Caloocan City, I notice that my bag
containing the said passbook was no longer in my
possession;

3. Despite diligent efforts, I could not locate the same and I

presumed it to be lost already;

4. I executed this affidavit to explain the loss of my Metrobank

Joint Account Passbook and for whatever purpose this may
serve.

In witness whereof, I signed this affidavit on this _____ day of

___________ 2019 in Caloocan City.

LORNA A. REAL
Affiant

Subscribed and sworn to before me on this ____ day of

_________ 2019 in Caloocan City. Affiant exhibiting to me her SSS
ID no. 03-7512766-3

Doc. No. ____

Page No. ____
Book No. ____
Series of 2019.