Republic of the Philippines

DONE: CITY OF BAGUIO

)
) SS.

AFFIDAVIT OF LOSS
I, RAIN ORID BULA-OY, of legal age, single, Filipino Citizen with residence and
postal address at J-A-127, Buyagan, La Trinidad, Benguet, after having been duly
sworn to in accordance with law do hereby depose and state that:
1. I am a driver of a Motor Vehicle, hence I secured and was issued a NONROFESSIONAL Drivers License by the Land Transportation Office thru the
Baguio City Office;
2. Last July 22, 2011, when I needed the said drivers license I look for it inside
our house but I could not found;
3. I exerted diligent efforts to locate the Non-Professional Drivers License but
the same could no longer be found, hence considered forever lost;
4. The said Non-Professional Drivers License has not been given nor pledged to
anyone for any purpose whatsoever, nor was it taken or confiscated by the
authorities for any violation of any law or traffic law or regulations;
5. I am executing this affidavit to attest to the truth of my foregoing statements
and for purposes of securing new Non-Professional Drivers License in lieu of
the lost one and for all legal intents and purposes it may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this 26th day of July 2011
at Baguio City, Philippines.

RAIN ORID BULA-OY

Affiant
SUBSCRIBED AND SWORN TO before me this 26th day of June 2011, at
Baguio City, Philippines, affiant personally known to me and the same person who
executed and signed this affidavit.

ATTY. MODESTO T. ANDONG

Notary Public
Commission No. 99-NC-10-R/Until: December 31, 2011
PTR No. 0480319/01-03-11/Baguio City
IBP No. 840993/1-5-11/Baguio-Benguet Chapter
Roll No. 31289/5-15-81/Manila
MCLE Compliance No. III-0000075/2-04-09
Doc. No.473;
Page No. 096;
Book No. I;
Series of 2011.