REPUBLIC OF THE PHILIPPINES )

DASMARIÑAS CITY, CAVITE ) S.S.

AFFIDAVIT OF LOSS
I, ANDREW M. PAREDES, of legal age, Filipino Citizen, and with postal and
residence address at Pasong Buaya I, Imus City, Cavite, after having been duly sworn to in
accordance with law, hereby depose and say:

That I am the owner/holder of Non-Professional Driver’s License issued at LTO Las

Pinas;

That unfortunately, the said Driver’s License allegedly snatched by unidentified person
while I was riding a jeepney along Edsa Extension route to Cavite;

That despite of diligent efforts, the said Driver’s License cannot be found and it was
considered as lost;

That the said Driver’s License was not confiscated by any legal authority or has no legal
pending case here in the Philippines;

That I am executing this affidavit to attest to the truth of the foregoing facts for all legal
intents and purposes.

IN WITNESS WHEREOF, I have hereunto set my hand this 27 th day of April 2023 at
Dasmarinas City, Cavite, Philippines.

ANDREW M. PAREDES
Affiant

SUBSCRIBED and SWORN to before me on the date and place above-written, affiant
exhibiting to me his/her Pagibig ID No. 1211-8014-9324.

Doc. No. 210

Page No. 42
Book No. 08
Series of 2023