Republic of the Philippines}

Ormoc City } S.S

AFFIDAVIT OF LOSS

I, ILUMINADA S. LAGUNA, of legal age, Filipino, married and a resident of Purok 1, Brgy.
Luna, Ormoc City, Leyte, after having been sworn in accordance with the law, hereby depose
and say:

1. That I am a tricycle operator with City Identification Number 1804 and have been
issued an Ormoc Tricycle Operator’ s Permit for the year 2022 by Business
Permits, Licensing and Franchising Office (BPLO) Ormoc City,.

2. That on April 10, 2023 I discover that the Tricycle Operator’ s Permit for the
year 2022 was lost and no longer in my files;

3. That I diligently searched for said Tricycle Operator’ s Permit for the year 2022
in the place I usually put other similar documents and in the places I believed I
might have misplaced it, however despite of my efforts and time exerted to look for
said Tricycle Operator’ s Permit for the year 2022 the same proved to be futile as
the above-mentioned Tricycle Operator’ s Permit for the year 2022 is nowhere to
be found;

4. That I am executing this affidavit in order to attest to the truth of the foregoing and
for any legal purpose this affidavit may serve;

IN WITNESS WHEREOF, I set my hand this April 19, 2023 at Ormoc City, Philippines. 

ILUMINADA S. LAGUNA
Affiant

SUBSCRIBED AND SWORN TO before me on April 19, 2023 at Ormoc City, Affiant
exhibiting to her Phil Health Id No. 13-201255991-0

Doc. No. _______;

Page No.________;
Book No. _______: Series
of 2023;