REPUBLIC OF THE PHILIPPINES )

MUNICIPALITY OF SAN JUAN ) SS.

PROVINCE OF LA UNION )

AFFIDAVIT OF LOSS

I, JIMES S. VELASCO, of legal age, single, Filipino citizen and a resident of Brgy.
Poblacion, San Gabriel, La Union after having been duly sworn on oath in
accordance with law hereby voluntarily depose and say:

1. That I am a tricycle driver and was issued by the LTO-SFLU a professional

driver’s licenses;

2. That I lost the said professional driver’s license when my waist bag
containing the same fell off my waist during my travel along the highway at
Urbiztondo, San Juan, La Union coming off from Brgy. Naguituban arch-marker;

3. That it appears that the waist bag containing my professional driver’s license
accidentally fell of between Naguituban and Forest Lake area because it was at
Forest Lake Park when I noticed that my waist bag was already missing;

4. That I exerted effort to locate my waist bag by tracing back my travel route
but my effort turned futile and the said waist bag containing my professional
driver’s license is considered lost forever and can no longer be found;

5. That I am executing this affidavit to attest to all the above facts and to
support my application for a new professional driver’s license before the LTO-SFLU
and for all legal intents and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto signed my name below, this 17th day
of July, 2020 at San Juan, La Union, Philippines.

JIMES S. VELASCO
Affiant
Res.Cert. No. 02624122, 7/17/2020

SUBSCRIBED AND SWORN to before me, this 17th day of JuLY, 2020 in San
Juan, La Union and affiant exhibited to me his competent proof of identity as
stated below his signature and printed name above.

__________________________
Notary Public