Republic of the Philippines ]

Province of Bohol ]
Municipality of Carmen ] S.S.

AFFIDAVIT OF LOSS
(Re: Driver’s License ID)

I, JASON G. VENCILAO, Filipino, of legal age, married and a resident of Katipunan,

Carmen, Bohol, Philippines, after being duly sworn in accordance with law, hereby depose and
say:

1. That I am a holder of a Non-Professional Driver’s License ID duly issued by the Land

Transportation Office, Tagbilaran City, Bohol, Philippines;

2. That said Non-Professional Driver’s License ID lost last March 5, 2022;

3. That I exerted diligent efforts to find and recover the aforesaid Non-Professional
Driver’s License ID, however, my efforts proved futile as until now, its whereabouts
still could not be ascertained, hence, I considered it to be lost for all intents and
purposes;

4. That the said Non-Professional Driver’s License ID was not transferred to any person
for consideration or used as collateral to secure obligations;

5. That I execute this affidavit voluntarily to attest to the truth of the foregoing
statements to support my request for the issuance of another Senior Citizen ID in lieu
of the lost one;

6. That further, I execute this affidavit for whatever legal purpose this may serve.

IN WITNESS WHEREOF, I hereunto set my hand this 14 th day of March, 2022 at

Carmen, Bohol, Philippines.

JASON G. VENCILAO
Affiant
VIN: 12120045BH0489JGV10000-5
Issued by COMELEC
Carmen, Bohol

SUBSCRIBED AND SWORN TO before me this 14th day of March, 2022 at Carmen,
Bohol, Philippines.