REPUBLIC OF THE PHILIPPINES )

PROVINCE OF PAMPANGA ) S.S

CITY OF SAN FERNANDO )

AFFIDAVIT OF LOSS

I, ALVIN B. ORSUA, Filipino, of legal age, single, and resident of

Brgy. Madapdap, Mabalacat City, Pampanga, after being duly sworn in
accordance with law, depose and state that:

1. I applied for a Non-Professional Driver’s License and was issued

an Official Receipt (OR) by the Land Transportation Office (LTO), City of
San Fernando, Pampanga in 2018;

2. Said Official Receipt served as my Temporary Driver’s License

while awaiting the card from LTO;

3. As I was about to claim my license card, I noticed that my OR was

no longer in my wallet and/or in my belongings;

4. Despite diligent search and efforts to locate the said receipt, I

could not find the same, such that I believe that it is now lost beyond
recovery;

5. As such, I am executing this Affidavit of Loss to attest to the truth

of the foregoing and to support my assertion that the original receipt
needed to claim my license card at LTO was lost.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

5th day of March 2020 in the City of San Fernando, Pampanga.

ALVIN B. ORSUA
Affiant

SUBSCRIBED AND SWORN to before me this 5th day of March

2020 at City of San Fernando, Pampanga, the affiant exhibiting to me his
Passport with No. P6372294A issued by the Department of Foreign Affairs
Angeles as competent proof of his identity.