REPUBLIC OF THE PHILIPPINES

MUNICIPALITY OF TUGUEGARAO CITY) SS.

PROVINCE OF CAGAYAN VALLEY)

AFFIDAVIT

I ARIANE JAY C. MACARUBBO of legal age, single and a resident of 260

soriano st. Pallua Sur Taguegarao City after having been duly sworn on oath in accordance
with law hereby voluntarily depose and say:

1. That I am a driver by profession, with License No.12345 issued by the

Board of transportation at Land Transportation office Tuguegarao District
office

2. That sometime between the months of June and July and I was at and
thereat earning my livelihood as driver for Mr. Batumbakal

3. That quite by accident, on the 25th day of June more or less, my wallet
fell from my hip pocket while I was on my way to work; that I noted the
loss only when, upon reaching my destination, I saw that my wallet was
gone, together with my driver’s License No 12345 and a little money.

4. That I took pains to look for said wallet and license but to no avail.

5.That I am executing this statement to attest to all the above facts, and to
request the proper authorities to grant me a new license.

IN TRUTH WHEREOF, I have hereunto signed my name below, this 28 day of

July 2000 at Tuguegarao City Police Station.

ARIANE JAY C. MACARUBBO

Affiant