REPUBLIC OF THE PHILIPPINES }

CAGAYAN DE ORO CITY } S.S.

AFFIDAVIT OF LOSS

I, _________________, of legal age, Filipino, married, and a resident of

_________________________, after having been duly sworn to an oath in accordance with
law, hereby depose and state that:

1. I am a duly licensed driver in accordance with pertinent Transportation

laws, rules, and regulations, and was issued a corresponding Non-Professional
Driver's License with number _________________;

2. On _______________, I noticed that the said driver’s license was misplaced

and got lost;

3. Efforts were exerted to locate the said driver’s license, but in spite of
diligent search, it could not be found and the same is now beyond recovery;

4. The said driver's license has not been confiscated by any law

enforcement agency;

5. Moreover, there has been no pending or unresolved case for

apprehension, alarm, suspension or revocation involving the said driver’s license;

6. As such, I am executing this Affidavit of Loss to attest to the truth of the

foregoing and to support my application for the issuance of a new
Professional Driver's License, in lieu of the one that was lost.

IN WITNESS WHEREOF, I have hereunto set my hand this 24 February 2020

in the City of Cagayan de Oro, Philippines.

__________________
Affiant

                                       
SUBSCRIBED AND SWORN to before me this 24th day of February 2020 in
Cagayan de Oro City, affiant exhibiting to me her Residence Certificate with No.
_________________ issued at Opol Misamis Oriental as competent proof of identification.

Doc No.  _____                                                             

Page No. ______                                           
Book No. ______                                              
Series of 2020.