REPUBLIC OF THE PHILIPPINES)

PROVINCE OF SURIGAO DEL SUR) S.S

AFFIDAVIT OF LOSS
KNOW ALL MEN BY THESE PRESENTS:

I, REY C. RELATORRES, Filipino, of legal age and a resident

Purok 9, Catanduan, Poblacion, Bislig City, after having been duly
sworn to in accordance with law, hereby depose and state, THAT:

1. I am a holder of a Driver’s License duly issued by the

Land Transportation Office (LTO).

2. At around 5:00 o’clock in the afternoon of May 26, 2021,

while travelling to Mangagoy, Bislig City riding my
motorcycle, I noticed that my clutch bag is no longer in
my possession.

3. The said clutch bag contained my Driver’s License.

4. I earnestly looked for my clutch bag but it can no longer

be found despite diligent efforts to locate the same.

5. Hence, I am of strong belief that the same is irretrievably

lost and beyond recovery.

6. I execute this affidavit to attest to the truth of the

foregoing and for whatever legal purposes it may serve
best.

IN WITNESS WHEREOF, I have here unto set my hand this

31 day of May 2021 in the City of Bislig, Province of Surigao del
st

Sur.

REY C. RELATORRES
Affiant
TIN: 488-080-179-000

SUBSCRIBED AND SWORN to before me on the date and place

first above written.

Doc. No. 175;

Page No. 35;
Book No. II;
Series of 2021.