Republic of the Philippines )

City of Taguig, Metro Manila) S.S.

AFFIDAVIT OF LOSS

I, MELVIN CHUA ALONZO, of legal age, Filipino Citizen, with residence and postal
address at #9 Licuanan St., Zone 5, Signal Village, Taguig City, Metro Manila, after having
duly sworn to in accordance with law do hereby depose and state:

That I am a holder and owner of a Professional Driver’s License issued by the Land
Transportation Office (LTO);

That on March 17, 2014, while looking for my wallet containing the aforesaid Driver’s
License placed inside my pocket, I found out that it was already missing, probably was
misplaced;

That I exerted all efforts to locate or find the said Driver’s License, but proved futile
and meaningless whatsoever;

That I am executing this AFFIDAVIT to attest to the truth and veracity of the above
statements for all LEGAL INTENTS and PURPOSES it may serve best.

IN WITNESS HEREOF, I have hereunto signed my name this 20 th day of March

2014 at City of Taguig, Metro Manila.

MELVIN CHUA ALONZO

Affiant

SUBSCRIBED & SWORN TO BEFORE ME this 20th day of March 2014 at City of
Taguig, Metro Manila, affiant exhibiting to me his SSS ID No. 33-1832345-0, issued by
Social Security System.

Doc. No. ____

Page No. ____
Book No. II
Series of 2014