Republic of the Philippines)

City of Cebu……………………..) S.S.

AFFIDAVIT OF LOSS

I, Leodegario L. Vivas, Filipino, of legal age, married, with postal address at Catadman,
Danao City, Cebu, after having sworn to in accordance with law do hereby depose and say:

1. That I am an employee of Filinvest Land, Inc. with office address at 2nd Floor, Grand
Cenia Building, Archbishop Avenue, Cebu City, Philippines, and at the same time a holder of a
Professional Driver’s License;

2. That on September 29, 2017, Friday at around 7:00 o’clock to 8:00 o’clock in the evening,
while I was at Purok 3 Mulmo, Compostela, Cebu, particularly on the spillway of the provincial
road, driving a motorcycle bound to Danao City, a flashed flood suddenly run off the spill way.
Unfortunately, the front wheel of the motorcycle that I was driving was hit with a piece of wood
washed away by the flashed flood, and caused it to loss balance and fall on its side. As a result,
the tool box of the motorcycle was opened and the flood washed away the things placed inside
including my wallet that contained my Professional Driver’s Licence and other ID’s;

3. That despite diligent search and efforts to locate my Professional Driver’s License and
because of the circumstances stated above, I could not find it such that I now believe that it is
now lost beyond recovery;

4. As such, I am executing this Affidavit of Loss to attest the truth of the foregoing and to
support my application for the issuance of a new Professional Driver’s License, in lieu of the
one that was lost;

IN WITNESS WHEREOF, I hereunto affix my signature this _____th day of November

2017, at Cebu City Philippines.

Leodegario L. Vivas
Affiant

SUBSCRIBED AND SWORN to before me, this _____th day of November, 2017 by MR.
LEODEGARIO L. VIVAS, who exhibited to me his ____________________ issued at
________________, Philippines on _____________________.

Notary Public

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of 2017.