Republic of the Philippines )

City of Taguig, Metro Manila) S.S.

AFFIDAVIT OF LOSS

I, MART NORBERT PARANE OPINA, of legal age, Filipino Citizen, with residence
and postal address at Block 60, Lot 13, Purok 1, Upper Bicutan, Taguig City, Metro Manila,
after having duly sworn to in accordance with law do hereby depose and state:

That I am a holder an AUTHORIZATION LETTER issued by the Land

Transportation Office (LTO), Paranaque Extension Office on May 12, 2014;

That sometime on June 2014, while looking for the aforesaid AUTHORIZATION
LETTER in my envelope where it was usually kept, I could no longer find the same,
probably was misplaced;

That I exerted all efforts to locate or find the said Driver’s License, but proved
futile and meaningless whatsoever;

That I am executing this AFFIDAVIT to attest to the truth and veracity of the above
statements for all LEGAL INTENTS and PURPOSES it may serve best.

IN WITNESS HEREOF, I have hereunto signed my name this 31 st day of December

2014 at City of Taguig, Metro Manila.

MART NORBERT PARANE OPINA

Affiant

SUBSCRIBED & SWORN TO BEFORE ME this 31 st day of December 2014 at City

of Taguig, Metro Manila, affiant exhibiting to me his Driver’s License No. N03-12-026683
valid until 2015-10-24, issued by LTO.

Doc. No. ____

Page No. ____
Book No. III
Series of 2014