REPUBLIC OF THE PHILIPPINES )

PROVINCE OF SURIGAO DEL NORTE ) S.S.

CITY OF SURIGAO )
x-----------------------------------------------/

AFFIDAVIT OF LOSS

I, ____________________, Filipino, of legal age, married and

residing at Purok 4, Barangay 12 Poblacion, Dapa, Surigao del Norte,
Philippines after having duly sworn in accordance with law hereby depose
and state that:

1. I am the same person mentioned above who have caused the

execution and preparation of this affidavit.

2. Sometime on the year 2015, I obtained a Professional Driver’s

License.

3. However, on December 16, 2021, the Municipality of Dapa was hit

and ravaged by Typhoon Odette causing great loss and damage to
the houses, including the place of my residence, and other
properties within and outside the herein Municipality.

4. The day after the landfall of the said typhoon, together with my
family, we cleaned and fixed the damage part of our house and as I
looked into my personal belongings, I noticed that my wallet
where all my valid Identification’s Card including my Driver’s
License were missing.

5. I tried to conduct further search, but unfortunately, the same was

beyond recovery and the sad thing is that it is nowhere to be found
despite diligent efforts to locate it.

6. For this reason, I executed this affidavit to establish the loss of the
said Driver’s License and sad to note that I was not able to
remember the Driver’s License Number.

7. Finally, I am also executing this affidavit to attest to the

truthfulness and veracity of the foregoing facts stated therein.

IN WITNESS WHEREOF, I have hereunto set my hands this

_______day of December, 2023 in Surigao City, Surigao del Norte,
Philippines.

______________________________
Affiant

1|Page
 SUBSCRIBED AND SWORN to before me in the Municipality
of Dapa, this ______day of December, 2023 by affiant, who have
satisfactorily proven to me her respective identity, that he is the same
person who personally signed before me the foregoing Affidavit of Loss
and acknowledged that he executed the same and avowed under penalty
of law to the whole truth of the contents of said instrument.

Doc. No. ______

Page No. ______
Book No.______
Series of 2023

2|Page