REPUBLIC OF THE PHILIPPINES )

CITY OF LAPU-LAPU ) S.S.

AFFIDAVIT OF LOSS

I, John Michael G. Baring, of legal age, Filipino, single, resident of

Bagumbayan I, Maribago, Lapu-lapu City, after having been sworn to in
accordance with law, do hereby depose and say:

1. That on December 13, 2017, I processed the renewal of my LTO ID,

and I was issued by the Office of the Land transportation with OR and
temporary permit to drive a motor vehicle.

2. That on February 9, 2018, our company collected our uniform where I

put my OR and temporary permit. And I forgot to get the aforesaid OR
and permit in my pocket and delivered the same to our company’s
laundry personnel.
3. When I realized that I left the aforementioned OR AND TEMPORARY
PERMIT, I tried to check them but unfortunately I cannot retrieve the
foregoing even though I exerted my best effort to recover them.
4. That I am executing this affidavit in order to attest the fact that my
Official Receipt and temporary permit were lost and now beyond
recovery.

In witness whereof, I have hereunto affixed my signature on this 10 th day

of February 2018, at Lapu-Lapu City.

John Michael G. Baring

Affiant

SUBSCRIBED AND SWORN TO BEFORE ME this 10th day of February 2018,

at Lapu-Lapu City, affiant exhibiting to me his competent identification card
Philhealth card with ID NO. 12-025477787-6, issued at Cebu City.
Doc No.____
Page No.____
Book No.____
Series of 2018.