Republic of the Philippines)

Province of Negros Oriental) S.S.

Municipality of Sibulan . . .)

AFFIDAVIT OF LOSS

I, RYAN S. CARIMAT, of legal age, single, Filipino and a resident of Agan-an,

Sibulan, Negros Oriental, after having been duly sworn to in accordance with law, state
and declare that:

1. I was previously issued a Non-Professional Driver’s License by the Land

Transportation Office (LTO) and I usually place it in my pocket;

2. That sometime on November 5, 2022, while I was driving my motorcycle

from Maslog, Sibulan, Negros Oriental going to Agan-an, Sibulan, Negros Oriental, I
noticed that my Non-Professional Driver’s License was not anymore in my pocket.
Perhaps, the said Non-Professional Driver’s License fell from my pocket or was
misplaced;

3. I have exerted diligent search and efforts to locate my Non-Professional

Driver’s License but the same has not been found or recovered up to the present such that
I now believe that it is now lost beyond recovery;

4. The said Non-Professional Driver’s License was not confiscated by any

law enforcement agency due to violations of traffic rules and regulations;

5. I am executing this Affidavit of Loss to establish the fact of loss of my

Non-Professional Driver’s License issued by the Land Transportation Office (LTO) and
to attest to the truthfulness and veracity of the foregoing facts.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 15 th day of

November 2022 in Sibulan, Negros Oriental, Philippines.

RYAN S. CARIMAT
Affiant

SUBSCRIBED AND SWORN to before me, a Notary Public, on this 15 th day of

November 2022, for the Municipality of Sibulan and the Province of Negros Oriental,
Philippines, the above-named affiant, who is personally known to me, WHO SIGNED
IN MY PRESENCE the foregoing document (Affidavit of Loss), and who avows under
PENALTY OF LAW to the whole truth of the contents of the same.

Doc No. 302;

Page No. 62;
Book No. VI;
Series of 2022.

Affidavit of Loss