Republic of the Philippines)

City of Davao )S.S.

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

AFFIDAVIT OF LOSS

I, ZANAIDA MARASIGAN BANZON, of legal age, Filipino,

married, and a resident of B28, L32, Illinois St., Kadayawan
Homes, Bangkal, Davao City, after having been duly sworn in
accordance with law, hereby depose and say that:

1. I am the person who caused the execution of this

affidavit;

2. I was a holder of a Driver’s License issued by the Land

Transportation Office (LTO) Davao City in 2016.

3. On July 29, 2018, my driver’s license was unfortunately

lost when I rode a public utility jeepney from Bangkal to
Claveria, Davao City. I surmise that I must have
inadvertenly left the same in the jeepney while I was
paying for my fare.

4. I exerted due diligence and persistent efforts in locating

the said driver’s license but to no avail and I now consider
the same as irretrievably lost;

5. I am executing this Affidavit to attest to the truth and

veracity of all the foregoing and in support of my request
for the issuance of a new driver’s license from the LTO as
a replacement for the lost one.

IN WITNESS WHEREOF, I have hereunto affixed my

signature this ______________at Davao City, Philippines.

ZANAIDA MARASIGAN BANZON

Affiant
UMID: CRN-0076-2836-6

SUBSCRIBED AND SWORN to before me this

_______________ at Davao City, Philippines. For purposes of
evidence of identity, affiant exhibited to me her identification
document as indicated above.

Doc No. ___;

Page No. ___;
Book No. ___;
Series of 2021.