REPUBLIC OF THE PHILIPPINES…)

CITY OF LAPU-LAPU …)S.S.

AFFIDAVIT OF LOSS

I, JUDIEL NINO BAGUIO CANE, of legal age, Filipino, and a resident of

Blk 6 Lot 7, Laris Homes, Subd., Basak, Lapu-Lapu City, Cebu, after having
been duly sworn to in accordance with law, hereby depose and state that:

1. That sometime in January 2020, I was issued a Temporary Operator’s

Permit (TOP) with TOP No. 15223100 by the Land Transportation
Office (LTO) – Region VII due to a traffic violation.

2. Said traffic violation also resulted in the confiscation of my Driver’s

License with License No. G11-18-000280;

3. Unfortunately, sometime on 23 September 2020, I lost the aforesaid

TOP while I was attending some personal errands.

4. I exerted earnest efforts to trace and locate the aforesaid TOP, but to
no avail;

5. I am executing this affidavit to attest to the veracity of the foregoing

statements and in order to secure a replacement of the above-
mentioned TOP and/or to claim my confiscated Driver’s License, and
for whatever legal purpose this may best serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 29 th

day of September 2020 at Lapu-Lapu City, Philippines.

JUDIEL NINO BAGUIO CANE

Affiant

SUBSCRIBED AND SWORN TO before me this 29 th day of September

2020 at Lapu-Lapu City, Philippines, affiant sufficiently proved his identity by
exhibiting to me his Police Clearance No. LLC9769491.

Doc No. ________

Page No. _______
Book No._______
Series of 2020.