Republic of the Philippines)

DONE: CITY OF BAGUIO…..) SS.

AFFIDAVIT OF LOSS
I, DAVELIX BOLINGAS ORDENIZA, of legal age, single, Filipino Citizen, and
resident of Evangelista St., Leonila Hill, Baguio City, after having been duly sworn to in
accordance with law do hereby deposes and states, that:

1. I am a holder of a Non-Professional Driver’s License which I usually kept in my

bag;

2. On January 13, 2023, I went to LBC, Bonifacio Branch, Baguio City to claim some
package. I used my license as proof of my identity and after that, I put it back to my
bag;

3. Yesterday, January 15, 2023, I noticed that my license was no longer in my bag. I
exerted diligent efforts to find my driver’s license but I failed and I even went back to
LBC if it happened that it was left there but they told me they returned it back, hence,
considered forever lost and beyond recovery. I am not sure how I lost it, maybe it-fell
off from my bag after my transaction at LBC or I just misplaced it;

4. The said DRIVER’S LICENSE has not been given nor pledged to anyone for any
purpose whatsoever, nor was it taken nor confiscated by the authorities for any
violation of traffic laws, rules and regulations;

5. I am executing this affidavit to attest to the truth of my foregoing statements and to

secure new DRIVER’S LICENSE in lieu of the lost one, and for all legal intents and
purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 16th day of January, 2023,
at Baguio City, Philippines.

DAVELIX BOLINGAS ORDENIZA

AFFIANT
BIR TIN No. 428-267-645-000
Issued On: 10-23-2012

SUBSCRIBED AND SWORN TO before me this 16th day of January, 2023, at Baguio
City, Philippines. Affiant personally appeared and to be the same person who executed this
instrument as his free act and deed.

MODESTO T. ANDONG
Notary Public
Comm. N.A.-56-NC-22-R until Dec. 31, 2024
PTR No. 4902764/1-04-2023
IBP OR No. 271717/1-5-2023
ROLL No. 31289/5-15-81/Manila
Doc. No. 40; BIR TIN No. 121-017-652-000
Page No. 08; ANDONG and ASSOCIATE LAW OFFICE
Book No. 61; No. 19 2nd flr., Old Market Building,
Series of 2023. Upper Magsaysay Ave., Baguio City, 2600