Republic of the Philippines )

City of Bacoor, Cavite ) s.s.

x-------------------------------------x

AFFIDAVIT OF LOSS

I, KELVIN JOHN M. FELONIA, of legal age, single, Filipino citizen,

and a resident of Block 5 Lot 5 Cocoville, Niog 2, Bacoor, Cavite, after having
duly sworn to in accordance with law, do hereby depose and state that:

1. Sometime in December 2018, I was looking for my Driver’s License;

2. I have looked everywhere to find my it but it was nowhere to be

found;

3. Diligent efforts to locate the same was exerted but it proved futile;

4. I am executing this affidavit to attest to the truthfulness of the

foregoing facts and for what legal intents and purposes it may
serve.

FURTHER AFFIANT SAYETH NAUGHT.

IN WITNESS WHEREOF, I hereby affix my signature on this ___ day of

April 2019 in the City of Manila.

KELVIN JOHN M. FELONIA

Affiant

SUBSCRIBED AND SWORN TO BEFORE ME on this

__________________ in the City of ____________. Affiant exhibiting to me
his__________________________, bearing his photograph and signature and
avowed the truthfulness of the foregoing declarations.

Doc. No. : _____

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