REPUBLIC OF THE PHILIPPINES)

Province of Zamboanga del Sur ) S.S.

City of Pagadian )
x--------------------------x

AFFIDAVIT OF LOSS

I, MC RONN S. EDAÑO, Filipino, of legal age, single, and a resident of

Pagadian City, Philippines, after being duly sworn to in accordance with law, do
hereby depose and state:

1 That 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 J03-18-002533 which is valid
until 06/27/2023;
2 That sometime last week, said Driver's License was misplaced and got lost;
3 That despite diligent search and efforts to locate my Driver's License, I
could not find the same such that I now believe that it is now lost beyond
recovery;
4 That 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 20 November

2018 at Pagadian City, Philippines.

MC RONN S. EDAÑO
AFFIANT

SUBSCRIBED AND SWORN to before me, this _______________, by the Affiant

who is personally known to me and who exhibited his ID No. J03-18-002533 issued at
Pagadian City.

Doc. No. ______;

Page No. ______;
Book No.______;
Series of 20____.