Republic of the Philippines }

CITY OF KIDAPAWAN } ss.

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

AFFIDAVIT OF LOSS

I, AMENADIEL VICTORIA , of legal age, Filipino, married and a resident

of Block 5 Lot 6 Apo Sandawa Homes-I, Kidapawan City, North Cotabato, after
having been sworn to in accordance with law, do hereby depose and state that:

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

Transportation laws, rules and regulations, and was issued a
corresponding Professionals Driver License with number D16-05-
301715 which is valid until January 2018;

2. That sometime in April 2017, said Drivers License was misplaced and
lost;

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

4. That said Drivers 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
Drivers License, in lieu of the one that was lost.

IN WITNESS WHEREOF, I have hereunto set my hand this 16th day

of June 2017 in Kidapawan City, Philippines.

AMENADIEL VICTORIA
Affiant
SSS ID No. 09-1858744-7

SUBSCRIBED AND SWORN to before me this this 16th day of June

2017 in Kidapawan City, Philippines, Affiant exhibiting to me his valid
identification document indicated below his name.

Notary Public

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2017.