Republic of the Philippines)

DONE: CITY OF BAGUIO…..) SS.

AFFIDAVIT OF LOSS
I, HENRY L. SANSANO, Jr., of legal age, single, Filipino Citizen, with residence and
postal address at No. 225 Kennon Road, Camp 7, Baguio City, Philippines, after having been
duly sworn to in accordance with law do hereby deposes and states that:

1. I am a holder of a PROFESSIONAL DRIVER’S LICENSE with license number

A05-12-005148 and valid until March 13, 2024 which was put inside a license jacket;

2. My aforesaid license was lost yesterday, August 24, 2022. Yesterday, I was walking
along Session Road, Baguio City and when I checked for it, I could no longer find it
in my pocket. I am not sure how I lost it, maybe it fell-off or slipped out while
walking;

3. I exerted diligent efforts to locate my DRIVER’S LICENSE but to no avail, hence,

considered forever lost;

4. The said DRIVER’S LICENSE has not been given nor pledged to anyone for any
purpose whatsoever, nor was it taken nor confiscated by the authorities for any
violation of traffic rules and regulations and for any law;

5. I am executing this affidavit to attest to the truth of my foregoing statements and to

secure new PROFESSIONAL DRIVER’S LICENSE in lieu of the lost one and for
all legal intents and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 25th day of August, 2022,
at Baguio City, Philippines.

HENRY L. SANSANO, Jr.

AFFIANT
Driver’s License No.: A05-12-005148
Valid Until:
3-13-24

SUBSCRIBED AND SWORN TO before me this 25th day of August, 2022, at Baguio
City, Philippines. Affiant personally appeared and to be the same person who executed this
instrument as his free act and deed.

MODESTO T. ANDONG
Notary Public
Commission No. 35-NC-20-R/Until: Dec. 31, 2021
(SC Extended- BM No. 3795)
PTR No. 5438254/12-29-2021/Baguio City (for 2022)
IBP Prov. No. 006934/1-03-2022
Roll No. 31289/5-15-81/Manila
Doc. No. 219; MCLE COMPLIANCE No. VI-0000192/June 14, 2016
Page No. 44; BIR TIN No. 121-017-652
Book No. 56; No. 19, 2nd Floor Old Market Bldg.,
Series of 2022. Magsaysay Ave., Baguio City, Philippines