Republic of the Philippines )

City of Butuan )S.S.

AFFIDAVIT OF LOSS

I, RHODELAINE CANDELARIO FAUSTINO, of legal age, single,

Filipino and a resident of Libertad, Butuan City after having been duly sworn
according to law, depose and state:

1. That I am a holder of a Student Permit (SP) issued by the Land

Transportation Office, Butuan City;

2. That I lost the said Student Permit sometime three weeks ago in
Hayanggabon, Surigao del Norte;

3. That I exerted all efforts to locate the same but could not find it and
considered it lost for all legal purposes;

4. That the said Student Permit was not confiscated by any officer of
the law by reason of any violation of any law, ordinance or
presidential decree, rules or regulation of the said Office;

5. That I am executing this Affidavit to inform the LTO of Butuan City

that the said Student Permit was lost and never recovered; and

6. That I attest to the truth of the foregoing facts.

FURTHER AFFIANT SAYETH NONE.

IN WITNESS WHEREOF, I have hereunto set my hand this 31st of May,

2017 in Butuan City, Philippines.

RHODELAINE C. FAUSTINO
Affiant

SUBSCRIBED and SWORN TO before me this 31st of May, 2017 in Butuan

City, affiant exhibiting to me her PRC I.D. No 0691560 with picture, as proof of her
identity.

Doc. No.: _________ ATTY. PEARL JOY M. SALAS

Page No.: _________ NOTARY PUBLIC
Book No.: _________ Commission until December 31 2017
Series of 2017 Roll No. 65035
IBP NO. 1061793 / 01-10-2017
PTR NO. 1260135 I 01-04-2017 /Butuan City
MCLE Compliance: Admitted to the Bar on 06-17-2016
TIN: 488-196-768
Purok-3 Libertad, Butuan City