REPUBLIC OF THE PHILIPPINES )

PROVINCE OF LAGUNA ) S.S.

MUNICIPALITY OF SANTA CRUZ )

AFFIDAVIT OF LOSS

I, RONALDO L. BARTOLOME, of legal age, Filipino, and a resident of Brgy.

Bagumbayan, Santa Cruz, Laguna after being duly sworn to in accordance with the law
do hereby depose and state:

1. That I was issued a Professional Driver’s License by the Land Transportation

Office;

2. That around February 2023, my Driver’s License got lost while I was in Sta.
Cruz, Laguna;

3. That upon realizing that the said license was missing, I tried to look for the
same;

4. That the said driver’s license can no longer be found despite diligent efforts to
look for the same and all my efforts turned futile;

5. That my driver’s license was not confiscated;

6. That I execute this affidavit to attest to the truthfulness of the foregoing

statement that my Driver’s License issued to me has been lost.

IN VIEW OF THE FOREGOING, I have hereunto affixed my signature this 8th

day of March 2023 at Santa Cruz, Laguna.

RONALDO L. BARTOLOME
Affiant

SUBSCRIBED AND SWORN to before me 8th day of March 2023 at Santa

Cruz, Laguna, affiant exhibiting his Voter’s Id with VIN 3426-0221A-E1862RLB10005-
5 as proof of his identity.

Doc. No. 481

Page No. 26
Book No. I
Series of 2023