REPUBLIC OF THE PHILIPPINES )

PROVINCE OF CAGAYAN
) S.S
CITY OF TUGUEGARAO
)

AFFIDAVIT OF LOSS
I, WENIFREDA A. DOMINGO, of legal age, married, Filipino citizen,
and a resident of Aurora, Isabela after having been duly sworn to in
accordance with law, do hereby depose and state under oath that
1. I am a holder of a vehicular plate issued by the Land
Transportation Office, Tuguegarao City, Cagayan;
2. At around 1 oclock in the afternoon last May 1, 2015; I
discovered that my vehicular plate bearing number XMW667 was then
missing. I went back to the places where I had been for I might have
just dropped it without me noticing it immediately hoping that I could
still find the same and that some good person might have seen the
same;
3. However, despite diligent search and effort to locate the said
drivers license, the same could no longer be found. Hence, it is
deemed lost and beyond recovery;
4. I am executing this affidavit to attest the veracity and
truthfulness of the foregoing facts that my Drivers License was indeed
lost and for whatever legal intents and purposes it may serve.
Further affiant sayeth naught.

IN WITNESS WHEREOF, I have hereunto set my hand this 4t h day

of May, 2015 at Tuguegarao City, Cagayan.

WENIFREDA A. DOMINGO
Affiant

SUBSCRIBED AND SWORN to before me this this this 4th day of May,
2015 at Tuguegarao City, Cagayan.

Doc. No. ________;

Page No. ________;

Book No. ________;
Series of 2015.