REPUBLIC OF THE PHILIPPINES)

BACOLOD, LANAO DEL NORTE) S.S.

AFFIDAVIT OF LOSS

I, MARTIN D. POMICPIC JR., of legal age, Filipino citizen, single and

residing at Poblacion, Bacolod, Lanao del Norte, after having been sworn in
accordance with law hereby depose and state:

1. I am a duly-licensed driver in accordance with pertinent Land

Transportation laws, rules and regulations, and was issued a Student
Permit (SP) to drive by the Land Transportation Office;

2. On March 16, 2020, I accidentally lost my wallet containing my SP;

3. Efforts were exerted to locate said wallet and SP, but in spite of diligent
search, it could not be found and the same is now beyond recovery;

4. Said permit has not been confiscated by the LTO, Police or other Traffic
Enforcers for any traffic violation;

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

foregoing and for whatever legal purpose this may serve.

Affiant Further Sayeth Naught

IN WITNESS WHEREOF, I have hereunto set my hand this 21st day of

May, 2020 at Bacolod, Lanao del Norte.

MARTIN D. POMICPIC JR.

Affiant

SUBSCRIBED AND SWORN TO before me, this this 21st day of May, 2020 at
Bacolod, Lanao del Norte.

ATTY. ALFONS JANSSEN P. MARCERA

Notary Public
Serial No. 19-229
Iligan City- Lanao del Norte
Until December 31, 2020
IBP Lifetime No. 01840
Roll No. 70427- July 31, 2017
Doc. No. : 427;
PTR No. 3838881- January 8,2019
Page No. : 86;
MCLE Compliance No VI- 0022669-8-18-18
Book No. : IX;
Series of 2020.