REPUBLIC OF THE PHILIPPINES)

LAOAG CITY………………………………) S.C

AFFIDAVIT OF LOSS

I, LAYLA DELIMA, of legal age, Filipino and a resident of Brgy. 1 Dik

Ammo Nga Road, Laoag City, Ilocos Norte, Philippines, after having been
sworn to in accordance of law hereby depose and say:

1. I was issued a NON-PROFESSIONAL DRIVER’S LICENSE by the Land

Transportation Office (LTO) with card no. R35-128-265;

2. I had been keeping the said license in my files at home. Recently, I

found out that my license was no longer in my files at home. Despite
diligent efforts, I did not find said missing license. Hence, I am now
considering the said license as lost and beyond recovery;

3. That my license has not been apprehended or cited for any violation of
a law or regulation;

4. I am executing this affidavit for the purpose of reporting to the Land

Transportation Office the fact of loss of said non-professional driver’s
license and to enable me to obtain a replacement for that license;

5. Further, I am executing this affidavit to attest to the truth of the

foregoing facts and for all legal intents it may serve well.

IN WITNESS WHEREOF, I have hereunto set my hand this 24th of

February 2020 at Laoag City, Philippines.

LAYLA DELIMA
Affiant
OSCA ID No. 11111

SUBSCRIBED AND SWORN to before me this 24th of February 2020 at

Laoag City, Philippines.

Doc. No. 3; ATTY.NICCOLO VITTORIO T. SANTOS

Page No. 1; Notary public
Book No. I; Brgy. 00 Baro a Laoag Street, Laoag City
Series of 2020. PTR No.1111111-01-01-2020, Laoag City
IBP No.1111111-01-01-2020, Laoag City
SC ROLL No.1
MCLE Compliance Certificate No.V-111, 01-01-2020