AFFIDAVIT OF LOSS OF A DRIVER’S LICENSE

Republic of the Philippines )

City of Dipolog - - - - - - - - -) S.S.

AFFIDAVIT OF LOSS

KNOW ALL MEN BY THESE PRESENTS:

I, JESSA MAE C. ENERO, of legal age, Filipino, married, and a resident of Sta. Isabel, Dipolog City,
after having been sworn in accordance with law, hereby deposes and states that:

1. I am a duly licensed driver in accordance with pertinent Land Transportation laws, rules and
regulations, and was issued a corresponding Non-Professional Driver’s License with number
JO2-20-265617 which is valid until December 9, 2025;

2. Sometime on September 2, 2021 said driver’s license was lost when my wallet carrying such
driver’s license was misplaced when I went to the City proper to do some errands;

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

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

5. As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing and to
support my application for the issuance of a new Non-Professional Driver’s License, in lieu of
the one that was lost;

IN WITNESS WHEREOF, I have hereunto set my hand this 4 th day of October 2021 in Dipolog City,
Philippines.

JESSA MAE C. ENERO

Affiant

SUBSCRIBED and SWORN TO before me, in Dipolog City, this 4 th day of October 2021, the affiant
exhibiting his Postal Identification Card No. 110654741356 issued by the Post Office at Dipolog City on
November 11, 2020.

WITNESS MY HAND AND SEAL.

Doc. No. 111 ATTY. JAMES CARL D. REID

Page No. 38 Notary Public
Book No. 2 Until December 31, 2022
Series of 2021 Attorney’s Roll No. 112245
IBP No. 2102465 01.23.2020 Dipolog City
PRT No. 2216546 01.23.2020 Dipolog City
MCLE Compliance No. XI-00000215421; 08.04.2020