Republic of the Philippines)

Province of  Cavite ) S.S.

Municipality of Alfonso ) 

AFFIDAVIT OF LOSS

I, SPHINE PASAOL ESPINELI, Filipino, of legal age, married and with

residence at Brgy. Mangas I, Alfonso, Cavite, Philippines, after being duly sworn to in
accordance with law, hereby depose and state:

1. On October 5, 2020, while I was riding a tricycle on my way home, I

accidentally dropped my card holder;

2. Included inside my card holder is my Professional Driver’s License with No.

D18-10-005445 which will expires on October 7, 2023 issued by Land
Transportation Office (LTO-Tagaytay);

3. Despite diligent search and efforts to recover the said Driver’s License the same
can no longer be located;

4. I am executing this affidavit to testify before any court of justice to substantiate

the truth of each and all the said facts.

IN WITNESS WHEREOF, I have hereunto set my hand this 6th day of October,
2020 at Province of Cavite, Philippines.

SPHINE PASAOL ESPINELI

Affiant

SUBSCRIBED AND SWORN to before me this 6th day of October, 2020 at

Alfonso, Cavite. Affiant personally appeared to this office.

WITNESS MY HAND AND SEAL.

Doc. No. 279 ;

Page No. 57 ;
Book No. LXXXV;
Series of 2020.