AFFIDAVIT OF LOSS

REPUBLIC OF THE PHILIPPINES )

BACOLOD CITY ) S.S.
I, Jose G. Montalbo, Filipino, of legal age, residing at V. Mapa Street
Barangay 40, Bacolod City, after having been sworn in accordance with law
hereby depose and state:
1. That I am the true and lawful owner of a professional driver’s license
duly issued in my name, license number F01-79-015075. Attached is a
true and faithful machine reproduced copy of the said license as proof
of that fact and as an integral part of this instrument as ANNEX “A”.

2. That sometime within the third week of May of 2020, I misplaced my

wallet, and contained therein is the said license.

3. That I exerted every effort to locate my wallet and the contents therein
but to no avail.

4. That I am executing this affidavit to attest to the truth of the foregoing

and to request from the Land Transportation Office of Bacolod City a
reissuance of the said Driver’s License or for whatever legal purposes.
IN WITNESS WHEREOF, I have hereunto set my hand this this 19th day of
May, in the year of 2020 in Bacolod City.

JOSE G. MONTALBO

SUBSCRIBED AND SWORN to before me, this 19th day of May, in

the year of 2020 in Bacolod City, with affiant personally known to me to be
the same person executing this affidavit, and his senior citizen ID with
control number 31249 issued at March 19, 2019.
ATTY. JOSHUA WILLIAM D. SU
NOTARY PUBLIC (NP 0115-20)
ATTY. JOSHUA WILLIAM D. SU
Unit 7, Green Building, Circle Inn Hotel Compound,
Doc. No. : 85 NOTARY PUBLIC (NP 0115-20)
Page No. : 17 Lopez-Jaena St.,Building,
Unit 7, Green BacolodCircle
City;Inn
Tel#(034)4342270
Hotel Compound,
Lopez-Jaena St., Bacolod City; Tel#(034)4342270
Book No. : III My commission expires
My commission ononDecember
expires December 31, 2020
31, 2020
Series of 2020. PTR No 8345248 dated at Jan 14, 2020 @ Bacolod City
PTR No 8345248
IBP dated at Jan 14,
OR No.093144 2020
dtd/ @ Bacolod City
10-11-2019
MCLE Compliance Order No.1, 2008
IBP OR Court
Supreme No.093144
Roll No.dtd/ 10-11-2019
72259 dtd. 6-14-2019

MCLE Compliance Order No.1, 2008

Supreme Court Roll No. 72259 dtd. 6-14-2019