REPUBLIC OF THE PHILIPPINES )

____________________________ ) S.S

AFFIFAVIT OF LOSS

I, NOEL P. BRINGAS, of legal age, married, Filipino and residing at

No. 123 Brigido Cruz St., Dalig, Teresa, Rizal, after having been duly sworn
in accordance with law hereby depose and state, That:

1. I am a holder of Philippine Driver’s License;

2. Sometime in September 2019, said Philippine Driver’s License

was misplaced and got lost;

3. Efforts were exerted to locate said Philippine Driver’s License, but

in spite of diligent search, it could not be found and the same is
now beyond recovery;

4. Said Philippine Driver’s License has not been confiscated by

authorities by reason of violation of existing rules and regulations;

5. As such, I am executing this Affidavit of Loss to attest to the truth

of the foregoing and to support my application for the issuance of
new Philippine Driver’s License, in lieu of the one that was lost.

IN WITNESS WHEREOF, I have hereunto set my hand this 1 st day of

October 2019 at Teresa, Rizal, Philippines

NOEL P. BRINGAS
Affiant

SUBSCRIBED AND SWORN to before me this _______ day of April

October 2019 at the __________________. Affiant exhibiting to me his
________________________________, as competent evidence of
identity.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2019.