Republic of the Philippines )

City of Iloilo ) S.S.

AFFIDAVIT OF LOSS

KNOW ALL MEN BY THESE PRESENTS:

I, ANA A. CRUZ, of legal age, Filipino, single/married, and a resident of

Bakhaw, Mandurriao, Iloilo City, after having been sworn in accordance with law, hereby
deposes and states the following:

1. I was issued a Driver’s License by the Land Transportation Office with ID No.
12345 valid until December 30, 2024;
2. I used to keep that ID in my wallet;
3. Last May 25, 2022, while I was in Jaro Plaza, my wallet together with my driver’s
license was stolen;
4. I have recently discovered the said item is irretrievably lost and can no longer be
found despite diligent efforts to locate the same;
5. I execute this affidavit to attest to the truth of the foregoing.

IN WITNESS WHEREOF, I have hereunto set my hand this 15 th day of June 2022 at Jaro, Iloilo
City.

(Sgd.) ANA A. CRUZ

Affiant

SUBSCRIBED AND SWORN to before me, this 15th day of June, 2022 in Iloilo City,
with affiant exhibiting his CTC No. 2671456, issued on January 25, 2022 at Iloilo City.

(Sgd.) ATTY. MERYSHEL S. GIANAN

Commission No. 12345
Jaro, Iloilo City
Expires on Dec 31, 2024
Roll of Attorney No. 123
IBP No. 34 January 1 2020, Iloilo City
PTR No. 56 February 5,2020, Iloilo City
MCLE Comp No/ 678
January 10, 2021
Lopez Jaena St. Jaro, Iloilo City; 333-4877
gmeryshel@gmail.com

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