REPUBLIC OF THE PHILIPPINES)

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

I, GERYNIE A. GARINGO, Filipino, of legal age, single, residing at Purok 3, Bulanao

Norte, Tabuk City, kalinga, after having been sworn to in accordance with law hereby
depose and state:
 
1. That I was issued a PROFESSIONAL DRIVER’S LICENSE by the
Land Transportation Office, Tuao, Cagayan on June 17, 2021;

2. That I put said driver’s license in the packet of my black belt bag
which I carried everyday in my work as a tricycle driver ;

3. That while I was waiting for a passenger, I went to chat with the
other drivers, and I forgot to bring with me black belt bag which I left in
the dashboard of my “ongbak”;

4. That when I arrived home and looked for my driver’s license, it

was missing and cannot be found;

3. That I exerted effort in trying to locate my driver’s license

hoping to recover the above-mentioned specimen but to no avail;

4. That the said professional driver’s 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 26th day of August
2021 at Bulanao, Tabuk City.

 
GERYNIE A. GARINGO
Affiant
         TIN No.: 732-164-909-000
 
          SUBSCRIBED AND SWORN to before me this 26th 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. 521
Page No. 106
Book No. XII
Series of 2021.