AFFIDAVIT OF LOSS REPUBLIC OF THE PHILIPPINES ) _____________________________ ) SS.

I, Redentor Marfega, Filipino, of legal age, married to Faith Marfega, and a resident of Blk 28 lot 8, J. Bralin St.,San Alfonso Homes, Brgy. Pacol, Naga city, after having been duly sworn in accordance with law, hereby depose and say: 1. That I am a holder of a Land Transportation License bearing license number EO4-95041774 issued by Land Transportation Office in Naga City; 2. That I used to put said license in my wallet, among others; 3. That sometime on April 20,2013, when I arrived home from work, I discovered that my wallet was no longer in my pocket where I used to place it; 4. That diligent effort to locate the same had proved futile; 5. That said license was not confiscated by the authorities of LTO or traffic enforcers by reason of any violation of traffic rules and regulations; 6. That I am executing this affidavit to attest to the truth of the foregoing facts and to request for a replacement and/or renewal of said license card from Land Transportation Office. IN WITNESS WHEREOF, I have hereunto affixed my signature this ____day of ____________ 20___ at ____________, Philippines.

_________________________________ (Signature of Affiant over Printed Name) SUBSCRIBED AND SWORN TO before me, a notary public in and for _____________________ this ____ day of ____________ 20___. The affiant, whom I identified through the following competent evidence of identity: Company Identification Card #0437, issued by H&Y Food Corporation, personally signed the foregoing instrument before me and avowed under penalty of law to the whole truth of the contents of said instrument.

Doc. No. ........; Page No. .......; Book No. .......; Series of 2010.