Republic of the Philippines]

Province of Cagayan ] S.S.

Tuguegarao City ]

AFFIDAVIT OF LOSS

I, ANTONIO G. ABEL, of legal age, single, Filipino, and a resident of Vista Del Rio,
Alimannao, Peñablanca, Cagayan and after having sworn to in accordance with law, hereby
depose and state:

1. That I was issued a Professional Driver’s License by the Land Transportation Office,
Tuguegarao City, Cagayan;

2. However, on the first week of April, 2012, I was apprehended by an Officer of the Land
Transportation Office while on board a motorcycle along Macapagal Avenue,
Tuguegarao City allegedly for Violation of Traffic Rules and Regulations;

3. As a consequence, I was issued by the apprehending officer of a Temporary Operating

Permit (TOP) but said TOP was loss, sometime in the 3rd week of April 2011, when I lost
my wallet where the same was placed;

4. That I exerted diligent efforts to locate the same it, but all my efforts proved futile;

5. That I am executing this affidavit in order to attest to the truth and veracity of the
foregoing statement.

FURTHER AFFIANT SAYETH NAUGHT.

IN WITNESS WHEREOF, I hereby affix my hand this 4th of May, 2012 at Tuguegarao City,
Cagayan.

ANTONIO G. ABEL
Affiant

SUBSCRIBED AND SWORN to before me this ____day of May, 2012 at Tuguegarao City,
Cagayan.

ATTY. JOEL T. DALIUAG

Public Attorney III
PUBLIC ATTORNEY’S OFFICE
Department of Justice
Carig, Tuguegarao City, Cagayan
(PURSUANT TO R.A. 9406)