REPUBLIC OF THE PHILIPPINES)

City of Manila) S.S.

AFFIDAVIT OF LOSS

I, LLOMAR M. MACARAIG, Filipino, of legal age, single, and a resident of Babangonan,

Victoria, Oriental Mindoro, after having been duly sworn in accordance with law, hereby depose and
say:
1. That I am the owner of a Driver’s License issued by the Land Transportation Office bearing
the name “Llomar M. Macaraig”;
2. That I lost said Driver’s License and that I exerted all efforts to locate the same but I could
no longer find it and it is considered lost for all legal purposes;
3. That said Driver’s License was not confiscated by any officer of the law by reason of any
violation of law, ordinance, or presidential decree and neither was it offered as collateral
for any loan;

4. That I am executing this affidavit to attest to the truth of the foregoing facts and to support
my application for a new Driver’s License and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 20 th day of April 2021 at
Manila, Philippines.

Llomar M. Macaraig
Affiant

SUBSCRIBED AND SWORN TO before me at the place and date above stated. I hereby
certify that I personally examined the affiant and am convinced that s/he voluntarily executed the
foregoing affidavit, read the same and understood its contents.

WITNESS MY HAND AND NOTARIAL SEAL

Doc. No. 115p

Page No. 23
Book No. II
Series of 2021.