REPUBLIC OF THE PHILIPPINES)

MANILA )S.S.

AFFIDAVIT OF LOSS

1. JOSHUA C. CUNANAN, of legal age, Filipino and a resident of No. 11 Palma

Street, La Residencia de Sta. Rosa, San Pedro, Laguna, after being sworn to in
accordance with law, hereby depose and say that:

2. I renewed my driver’s license at Ayala-LTO branch sometime in first quarter

of 2017;

3. That Ayala-LTO issued to me the Driver’s License sometime in October 2017;

4. I usually place the said driver’s license inside my motor vehicle;

5. On or about 9 in the morning of 22 April 2018, I went to car wash station

located near Paseo de Sta. Rosa, Sta. Rosa, Laguna;

6. On 23 April 2018 in the morning, as I ordinary and usually checked my things

before leaving home, I found no driver’s license inside my car;

7. I lost no time in diligently trying to locate the said driver’s license but all efforts
exerted proved futile and no to avail, and the same is considered lost and beyond
recovery;

8. I am executing this affidavit for any legal purposes it may serve.

AFFIANT FURTHER SAYETH NAUGHT.

JOSHUA C. CUNANAN
Affiant

SUBSCRIBED and SWORN to before me this ____day of ________ 2018 at

________________________ affiant exhibited to me his Integrated Bar of the
Philippines identification card.

Doc. No.______
Book No.___
Page No._____
Series of 201_