REPUBLIC OF THE 

PHILIPPINES )
Province/City__________________  ) SS.

AFFIDAVIT OF LOSS

I, Natalie M. Abano, Filipino Citizen, of legal age, and presently residing at Block 2 Lot
17, San Luis Villa, Habay 1, Bacoor City, Cavite, after having been duly sworn to in
accordance with law, hereby depose and state:

1. I am a holder of a non-professional drivers license with number N25-21-001586.

2. I have recently discovered the said item is irretrievably lost and can no longer be found
despite diligent efforts to locate the same;
3. I execute this affidavit to attest to the truth of the foregoing.
Signed on the date and at the place indicated below.

SUBSCRIBED and SWORN TO before me on the date and at the place

indicated below. The affiant exhibited to me his competent evidence of identity as
indicated above.

Signed this __________at ,_________Philippines. WITNESS MY HAND

AND SEAL.

_______________
Affiant

Doc No.
Page No.
Book No.
Series of 2021