Republic of the Philippines)

) S.S.

AFFIDAVIT OF LOSS

I, LEONCIO P. CERON, JR., of legal age, Filipino and a resident of

2830 Lansones Street NAPICO, Brgy. Manggahan Pasig City after having
been duly sworn to in accordance with law, do hereby depose and state:

1. That I am a lawful holder of a Non-Professional/Professional

driver’s license issued by the Land Transportation Office.
2. That I have unfortunately lost my wallet containing my driver’s
license.
3. That efforts were exerted to locate the wallet with my driver’s
license, but in spite of diligent search, it could not be found and the same is
now beyond recovery.
4. That said Driver’s License has not been confiscated by the LTO,
Police or other Traffic Enforcers for any traffic violations.

5. As such, I am executing this Affidavit of Loss to attest to the

truth of the foregoing, and to support my application for the issuance of a
new (Non) Professional Driver’s License, in lieu of the one that was lost.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

25th day of August, in Pasig City, Philippines.

LEONCIO P. CERON, JR.

Affiant

SUBSCRIBED AND SWORN to before me this _____day of

__________ 2023 in _______________ Philippines, affiant personally
appeared before me, signed/affixed his Competent Evidence of Identity by way
of _________________ issued at ___________________ on
________________.

Doc. No. ________;

Book No. ________; NOTARY PUBLIC
Page No. ________;
Series of 2023