Republic of the Philippines )

Quezon City ) s. s.

AFFIDAVIT OF LOSS

I, DON CARLO DEL ROSARIO MALONZO, 37 years of age, Filipino, single

and a resident of No. 2 JP Rizal Street, Dona Faustina, San Bartolome, Novaliches,
Quezon City after having been duly sworn on oath in accordance with law, hereby depose
and state, THAT-

1. I am holder of Professional Driver’s License No. N25-07-004285 duly

issued by Land Transportation Office, Zabarte;

2. That said driver’s license will expired on October 31, 2024;

3. However, on April 23, 2020, the said license and voter’s identification card
was lost, when my wallet fell and I notice only the lost upon reaching my home;

4. I took diligent effort to look for the said license but to no avail;

5. I am executing this statement to attest to all the above facts and to request
the Land Transportation Office for the issuance of new/duplicate driver’s license.

IN WITNESS WHEREOF, I have signed my name below this 26th day of May,
2020 at Quezon City, Philippines.

DON CARLO DEL ROSARIO MALONZO

Affiant

SUBSCRIBED AND SWORN to before me this 26th day of May, 2020 at Quezon
City, Philippines, affiant exhibited to me his valid identification card as competent proof
of his identity.

Doc. No.:
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Series of 2020