Republic of the Philippines )

Malaybalay City ) s.s.

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

AFFIDAVIT OF LOSS

I, ANGELO FERNANDEZ BALITON legal age, Single, resident of Malaybalay

City after having sworn in accordance with law, do hereby depose and state THAT:

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

Transportation laws,rules and regulations, and was issued a corresponding Non -
Professional Driver's License with number D16-05-301715 which is valid until
January13,2030;

02. Sometime in February 1 2024 , said driver's license was misplaced and
got lost;

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

04. Said Driver's License has not been confiscated by the LTO, Police or
otherTraffic Enforcers for any traffic violation.

05. As such, I am executing this Affidavit of Loss to attest to the truth of the
foregoingand to support my application for the issuance of a new Non - Professional
Driver's License, inlieu of the one that was lost;

IN WITNESS WHEREOF, I have hereunto set my hand this 1 day of March ,

2024 at the City of MALAYBALAY

IN WITNESS WHEREOF, I hereunto affixed my signature this 1 day of March at

Malaybalay City

_______________________________
Affiant

SUBSCRIBED AND SWORN to before me this 1 day of March at Malaybalay

City I HEREBY CERTIFY that I have personally examined the herein affiants and I am
satisfied that they voluntarily executed and understood their given affidavit.

Notary public

Doc. No. ;
Page No. ;
Book No. ;
Series of 2024.