AFFIDAVIT OF LOSS

I, ANTONIO JOSE LINGAN Jr., of legal age, Filipino citizen, and a

resident of Brgy. 48-B Cabungaan, Laoag City, Ilocos Norte, Philippines, after
having been duly sworn to in accordance with law, depose and state THAT:

1. I am a duly licensed driver in accordance with pertinent Land

Transportation laws, rules and regulations, and was issued a
corresponding Driver's License with a License No. A03-0204-6122;

2. Sometime on the 29th day of July at 9 o’clock in the evening, said driver's
license was misplaced and got lost;

3. Efforts were exerted to locate said driver's license, but in spite of diligent
search, it could not be found and the same is now beyond recovery;

4. Said Driver's License has not been confiscated by the LTO, Police or
other Traffic Enforcers for any traffic violation; and

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 set my hand this 3rd day of

August 2023 in Laoag City, Ilocos Norte, Philippines.

ANTONIO JOSE LINGAN Jr.

Affiant
ID No. _______________________

SUBCRIBED AND SWORN TO before me this 3rd day of August 2023 in

Laoag City, Philippines.

Doc. No. 181 KENNETH PAUL CHRISTIAN M. AGUSTIN

NOTARY PUBLIC
Page No. 38 Province of Ilocos Norte and Laoag City
Book No. II Commission No. 2022-40 Until Dec 31, 2023
Series of 2023 Roll of Attorneys No. 78877 – May 14, 2022
IBP No. 211222 – May 15, 2022
PTR No. 2456348 – Jan 3, 2023
MCLE Exempt pursuant to Governing Board Order No. 1, s. 2008
TIN 725-636-881-00000