Republic of the Philippines )

City of Cabanatuan )
Province of Nueva Ecija )s.s
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AFFIDAVIT OF LOSS

I, FERNANDO M. BULANADI, of legal age, married, Filipino, and a

resident of Barangay Matias, Talavera, Nueva Ecija, after having duly sworn
to, in accordance with law, hereby states:

1. That I am a holder of a Student Drivers License issued by LTO-Baloc,

Sto. Domingo, Nueva Ecija;

2. That sometime the second week of September 2017, I went to the

Public Market of Talavera, Nueva Ecija on board a tricycle unit;

3. That upon arrival at our resident at Barangay Matias, Talavera,

Nueva Ecija I noticed that my wallet were my Drivers License was
located;

4. That I immediately returned to the Talavera Public Market and

exerted all efforts to locate it but all my efforts were in vein;

5. That I am executing this affidavit in order to declare the

circumstances surrounding the loss of my Drivers License and also
to support my application for a new one.

IN TRUTH WHEREOF, I have hereunto affixed my signature this 26 th day

of September 2017 hereat Talavera, Nueva Ecija.

FERNANDO M. BULANADI
(Affiant)
UMID ID NO. CRN-0111-3943940-2

SUBSCRIBED AND SWORN TO, before me on this 26 th day of September

2017 hereat Talavera, Nueva Ecija.