Republic of the Philippines)

C I T Y O F D A V A O)s.s
x-------------------------------------x

AFFIDAVIT OF LOSS

I, MA YSABELLA L. TERUEL, of legal age, Filipino and a resident of

Davao City, upon my oath do hereby depose and say:

1. That I am a holder of a Driver’s License Card with No. L11-18-

000100 duly issued by the Land Transportation Office (LTO);

2. That I placed said Driver’s License Card inside my wallet for

safekeeping;

3. That on or about 8:00 pm on December 20, 2022, I accidentally left

my wallet containing the above-mentioned Driver’s License in one
of the food stalls of the grocery area of SM Ecoland, Davao City.
That I was not able to retrieve the said wallet as I immediately left
the area;

4. That I exerted all efforts to recover said Driver’s License Card but
my efforts proved futile as the same could no longer be found
despite diligent search. Hence, I considered the same lost for all
intents and purposes;

5. That I execute this affidavit to attest to the truth of the foregoing

facts and for whatever legal purposes.

IN WITNESS WHEREOF, I have hereunto set my hand this

__________________________ at Davao City, Philippines.

MA YSABELLA L. TERUEL
Affiant

SUBSCRIBED AND SWORN to before me this of

_______________________ in the City of Davao, Philippines. Affiant is
exhibited to me her __________________ as proof of her Identity.

Doc. No. ______;

Page No.______;
Book No.______;
Series of 2023.