Republic of the Philippines)

Malolos City, Bulacan )S.S.

x--------------------------------x

AFFIDAVIT OF LOSS

I, MATTHEW AUREL BAQUING, of legal age, Filipino, and

presently residing at 10 Ampola Street, Bahayang Pag-Asa, Maysan,
Valenzuela City, after having been duly sworn to in accordance with law do
hereby deposes and states, that:

1.) I am a holder of LTO Professional Driver’s License with License No.

C07-17-027320, duly issued to me by the Land Transportation Office;

2.) On January 16, 2021, while riding my motorcycle traversing the Vista
Verde Road, I decided to stop nearby to use comfort room;

3.)I left my bag on my motorcycle. Unfortunately, when I came back, I

noticed that my bag was missing, it might stole my bag by a thief;

4.)The said bag contains my Philippine Passport, wallet, some keys, and
the subject LTO Driver’s License;

5.) I have exerted diligent effort to locate the same but all my efforts are
all in vain; and

6.)I am executing this Affidavit to attest to the truth and veracity of the
foregoing set of facts and to inform the authorities thereof for all legal
intents and purposes it may serve.

Malolos City, Bulacan, January 19, 2022.

MATTHEW AUREL BAQUING

Affiant

SUBSCRIBED AND SWORN TO BEFORE ME this 19th day of

January 2022, hereat Malolos City, Bulacan.

Doc. No. 331;

Page No. 68;
Book No. XX;
Series of 2022.