REPUBLIC OF THE PHILIPPINES)

Province of Pangasinan) S.S.

Municipality of Malasiqui)
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AFFIDAVIT OF LOSS

I, Reymund Castillo, Filipino, of legal age, married, and a resident of Malasiqui, Pangasinan,
Philippines, after being duly sworn to in accordance with law, hereby depose and state:

1 That I am an employee of DEPED at Malasiqui National High School and at the same time a
duly-licensed non-professional driver;

2 That on March 5, 2018 at around 5pm, while I was at the school at Malasiqui National High
School, I lost my wallet which I usually place in my back pocket;

3 That inside the said wallet is my Driver's License issued at LTO San Carlos City Pangasinan;

4 That despite diligent search and efforts to locate the said wallet and my Driver's License, I
could not find it such that I now believe that it is now lost beyond recovery;

5 That my Driver's License has not been confiscated by the LTO, Police or other Traffic Enforcers
for any traffic violation;

6 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 Driver's License in lieu of the ones that was
lost.

In WITNESS WHEREOF, I have hereunto set my hand this 25th April, 2018 at Malasiqui, Pangasinan,
Philippines.

REYMUND CASTILLO
AFFIANT

CHRISTOPHER A. MARTIN

Notary Public

My Commission Expires: 31 December 2018

IBP No. 764814 dtd. 01-07-18 Malasiqui Pangasinan
PTR No. 5448574 /01/14/18/ Malasiqui Pangasinan
Roll No. 33476
MCLE Compliance II – 0009328 Dtd. March 27, 2018
Doc. No. 5
Page No. 3
Book No. 1
Series of 2018.