Republic of the Philippines )

Province of Negros Oriental) S.S.

MUNICIPALITY OF SIBULAN )
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AFFIDAVIT OF LOSS

I, JEFFREY ABLAY WILLIAMS, of legal age, single, Filipino, and a resident of,
Barangay Maslog, Sibulan, Negros Oriental, after having been sworn to in accordance with
the law, do hereby depose and say the following, to wit:

That last April 11. 2020 I delivered parcels for delivery at Sibulan Country Homes in
Sibulan and that I always carry with me my Professional Driver’s License, among others,
inside my wallet;

That it was on the same date wherein upon arrival at the Dumaguete Check Point area
discovered that my wallet was already missing which contained my Driver’s License, a
machine copy of the Official Receipt and Certificate of Registration of the motorcycle which
I am driving and other important cards and bills;

That I tried to retrace my route in the hope of finding my wallet, and even inquired
from the other members of the family but all such efforts proved futile and unproductive as
the said wallet, including my Driver’s License could no longer be found;

That I tried to retrieve my Driver’s License but to my great dismay the same could no
longer be found and for which reason I now conclude that my Professional Driver’s License
is already lost and irretrievable for all legal intents and purposes;

That I am executing this affidavit, freely and voluntarily, in order to attest to the
veracity of the facts above-stated and in order to support my request for the issuance of a new
Professional Driver’s License in lieu of the lost one, and in the meanwhile, be allowed to do
some transactions pending receipt of the replacement license;

IN WITNESS WHEREOF, I hereby affix my signature this 17 th day of April, 2020

at Sibulan, Negros Oriental.

JEFFREY ABLAY WILLIAMS

(Affiant)

          SUBSCRIBED AND SWORN TO before me this 17th day of April, 2020 at Sibulan,
Negros Oriental, affiant exhibited to me his Unified Multipurpose ID (UMID) - CRN 0116-
0377663-2 as a competent proof of his identity.

JOSE A. ABIERA
Municipal Mayor