REPUBLIC OF THE PHILIPPINES)

PROVINCE OF SURIGAO DEL SUR) S.S

AFFIDAVIT OF LOSS
KNOW ALL MEN BY THESE PRESENTS:

I, JOHN MICHAEL REYES, Filipino, of legal age and a resident of Purok 1,

Gamaon District, Mangagoy, 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 Authority bearing license number L01-14-000480.

2. Recently, a fire occurred at my workplace at MLhuillier Andres

Soriano Ave. Branch, Mangagoy, Bislig City.

3. The said driver’s license was left inside my workplace when the fired
burned the building, thus, the same is considered irretrievably lost.

4. I execute this affidavit to attest to the truth of the foregoing and

whatever legal purposes it may serve best.

IN WITNESS WHEREOF, I have here unto set my hand this 11 th day of

August 2021 in the City of Bislig, Province of Surigao del Sur.

JOHN MICHAEL REYES

Affiant
Driver’s License No. L01-14-000480

SUBSCRIBED AND SWORN to before me on the date and place first above
written.

Doc. No. 324;

Page No. 65;
Book No. II;
Series of 2021.