REPUBLIC OF THE PHILIPPINES)

PROVINCE OF KALINGA )
TABUK CITY ) S.S. 
                                                     
AFFIDAVIT OF LOSS 

I, MARK JOSEPH A. ABAD, Filipino, of legal age, single, residing at Banguilan,

Tuguegarao City, Cagayan after having been sworn to in accordance with law
hereby depose and state:
 
1. That I was issued a NON-PROFESSIONAL DRIVER’S
LICENSE by the Land Transportation Office, Tuguegarao City,
Cagayan on February 27, 2019;

2. That I safely kept said license in my wallet;

3. That sometime on January 16, 2021 in San Jose Del

Monte, Bulacan, my wallet where I kept my Driver’s License was
lost;

3. That I exerted effort in trying to locate my wallet hoping to

recover the above-mentioned specimen but to no avail;

4. That the said license was lost in the manner stated above
and not confiscated nor cancelled by the issuing agency or any
instrumentality of the government

          5. That I am executing this affidavit to attest the truth of the

foregoing and for whatever legal purposes it may serve.
 
IN WITNESS WHEREOF, I have hereunto set my hand this 17th day of
August 2021 at Bulanao, Tabuk City.

 
MARK JOSEPH A. ABAD
Affiant
         PhilHealth No. 06-050244831-8
 
          SUBSCRIBED AND SWORN to before me this 17th day of August 2021,
by the affiant who personally appeared and presented to me a competent proof
of his identity, the particulars of which are indicated below his name and
signature and that he is the same person who signed the foregoing affidavit
before me and acknowledged that he executed the same 

 
Doc. No. 487
Page No. 99
Book No. XII
Series of 2021.