AFFIDAVIT OF LOSS

 
 
Republic of the Philippines)
Province of Camarines Sur ) S.S. 
CITY OF IRIGA )
                                                     
 
I, DANILO C. BAGACINA, married, Filipino, of legal age and residing at Taurus
Street, Villa Grande Homes, Conception Grande, Naga City, after having been sworn to
in accordance with law hereby depose and state:
 
I have always kept the Driver’s License Receipt (DLR) inside my wallet along
with my other Identification cards, money and some receipts;
4. Sometime in April 2018, I was looking for the Driver’s License Receipt (DLR but
to my surprise, said Driver’s License Receipt (DLR) could not be found;
5. I came to believe I accidentally threw away the said receipt together with the
other receipts in my wallet;
6. Despite diligent efforts exerted, I could no longer locate, find, or recover the
said Driver’s License Receipt (DLR), and to the best of my knowledge, the
same is truly lost;
7. For verification purposes, attached as Annex “A” is my Postal ID No. PAN
E14160182004 B;
8. I am executing this Affidavit of Loss to attest to the truth of the foregoing and to
support for the issuance of my Driver’s License ID.
AFFIANT FURTHER SAYETH NAUGHT
That on May 27, 2023 at _______________, our store was burned and
destroyed by fire.

That as a result, my belongings and personal properties were destroyed or

lost, to wit:

______________
______________
______________
______________
______________
______________;

That I took pains to salvage and recover the foregoing items or properties,
but to no avail;

That I am executing this affidavit to attest to the truth of the foregoing and
for whatever legal purpose/s it may serve.
 
IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of June 2023 at
Iriga City, Philippines.
 
                  
                    DANILO C. BAGACINA
Affiant   
     
 
          SUBSCRIBED AND SWORN to before me, this ____ day of ______________, 2023
in ___________________ City, with affiant exhibiting his identification
__________________________, issued on ______________________ at
_________________________.