REPUBLIC OF THE PHILIPPINES)

CITY OF IMUS, CAVITE ) S.S.

x---------------------------------x

AFFIDAVIT OF LOSS

I, JOHN JERWIN P. ANGUE, of legal age, Filipino, single, and a resident of Bucal 2,
Maragondon, Cavite, 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 number N26-17-017707 which is valid until May 1, 2032;

2. Sometime in December 2022, said driver's license was misplaced and got lost;

3. Efforts were exerted to locate said driver's license, but despite 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;

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 Driver's License, in lieu
of the one that was lost;

IN WITNESS WHEREOF, I have hereunto set my hand

this ___________________ in ___________________, Philippines.

JOHN JERWIN P. ANGUE

Affiant

SUBCRIBED AND SWORN TO before me this ___________________ in

_________________, Philippines, affiant exhibiting to me his/her competent evidence
of identity by way of __________________ issued at ______________
on __________________.

Doc. No. _____;

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