REPUBLIC OF THE PHILIPPINES)

DONE IN THE CITY OF BAGUIO) S. S.

x----------------------------------------------x

AFFIDAVIT OF LOSS
TEMPORARY OPERATOR’S PERMIT

I, CLINT JOE DUMAYAG BACBAC , of legal age, Filipino, and a

resident of Betag, La Trinidad, Benguet , after having been duly sworn in
accordance with law do hereby depose and state that:

1. I was issued a professional driver’s license by the LTO- Licensing Office ;

2. I was apprehended for traffic violation and I was issued a Temporary

Operators Permit (TOP) bearing No. 17492378 by the DOTr Law
Enforcement Personnel ;

3. The said T.O.P was safely kept in an envelope together with some other
equally important document which such envelope was kept inside the
compartment of my motor vehicle. However, when I needed such document I
noticed that it was no longer in the envelope where I have kept it. I believe
that the document was loss when I parked my motor vehicle along Pacdal
Road Baguio City;

4. I exerted diligent efforts to locate for the loss of the said T.O.P by looking
into places where they might have been thrown away, or misplaced, and by
inquiring as to whoever might have taken it, but, unfortunately, all my
efforts were in vain. I strongly believe that my said T.O.P is lost and beyond
recovery;

5. I am executing this affidavit to attest to the truth of the foregoing facts and
for all legal intents and purposes this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

12th day of March 2019 in the City of Baguio, Philippines.

CLINT JOE D. BACBAC

Affiant
TIN 500 039 601

SUBSCRIBED AND SWORN to before me this 12th day of March

2019 at Baguio City, Philippines. Affiant exhibited to me his competent proof
of identity as maybe shown below his name and signature.

RICHARD B. KILAAN
Doc No. 65 Notary Public
Page No. 13 Until December 31, 2019
Book No. XIX PTR No. 3956007; January 3, 2019
Series of 2019 IBP LIFETIME Membership No. 06440
Roll No. 44714; May 12, 1999
NA NC 59-NEW-18
MCLE Compliance No. V-0026319; 4-14-19
Unit 2 St.Joseph Bldg.,Pacdal , Baguio City