REPUBLIC OF THE PHILIPPINES )

Province of Davao del Norte )

City of Tagum )S.S
x-------------------------x

AFFIDAVIT OF LOSS

I, RICHARD L. RAMOS, Filipino, married, of legal age and a resident of

Purok 4, Barangay Conception, Montevista, Davao de Oro, Philippines, after
having been duly sworn to in accordance with the law, do hereby depose and
say;

1. That I am a holder/owner/ possessor of a Driver’s License Official Receipt

issued by the Land Transportation Office Nabunturan Branch;

2. That I was in possession of the said official receipt from the time of its issuance
but sometime in first week of March 2021, upon reaching home, I discovered
that said official receipt was no longer found in my pocket. I supposed there
and then that the same must have fallen along the way;

3. That I now deem that the said official receipt to have lost for all purposes and
intents after the same was not located despite diligent efforts;

4. That I now request Land Transportation Office of Nabunturan Office to issue a

new official receipt in lieu of the lost one and I bind myself to surrender the
lost official receipt in the event that the same is found and/or located;

5. I am executing this Affidavit to attest to the truth and veracity of the foregoing
statements and to apprise the proper authorities concerned on the matter for
their information, guidance and for whatever legal purpose/s this may serve
best.

IN WITNESS WHEREOF, I have hereunto set my hand this____ day of

__________________ at _________________________, Philippines.

RICHARD L. RAMOS
Affiant
ID No.___________

SUBSCRIBED AND SWORN to before me this _____ day of

________________________at ________________________, Philippines.

Doc. No. ____

Page No. ____;
Book No. ____;
Series of 2021.
 REPUBLIC OF THE PHILIPPINES )
Province of Davao del Norte )
City of Tagum )S.S
x-------------------------x

AFFIDAVIT OF LOSS

I, JUVELYN DECATORIA, Filipino, single, of legal age and a resident of

Purok II Bantacan, New Bataan, Davao de Oro, Philippines, after having been
duly sworn to in accordance with the law, do hereby depose and say;

6. That I am a holder/owner/ possessor of an ATM Card No.5166-0341-18 issued

by the Landbank of the Philippines Nabunturan Branch, Davao de Oro;

7. That I was in possession of such ATM Card from the time of its issuance but
sometime in December 15, 2020, upon reaching home, I discovered that said
ATM Card was no longer found in my pocket. I supposed there and then that
the same must have fallen along the way;

8. That I now deem that the said ATM Card to have lost for all purposes and
intents after the same was not located despite diligent efforts;

9. That I now request the Landbank of the Philippines Nabunturan Branch to issue
a new ATM Card in lieu of the lost one and I bind myself to surrender the lost
ATM Card in the event that the same is found and/or located;

10.I am executing this Affidavit to attest to the truth and veracity of the foregoing
statements and to apprise the proper authorities concerned on the matter for
their information, guidance and for whatever legal purpose/s this may serve
best.

IN WITNESS WHEREOF, I have hereunto set my hand this____ day of

__________________ at _________________________, Philippines.

JUVELYN DECATORIA
Affiant
ID No.___________

SUBSCRIBED AND SWORN to before me this _____ day of

________________________at ________________________, Philippines.
Doc. No. ____
Page No. ____;
Book No. ____;
Series of 2021.