Republic of the Philippines]

City of D U M A G U E T E] S.S.

AFFIDAVIT OF LOSS

I, MARVILIE M. SERNA of legal age, Filipino, single, and a

resident of Valencia, Negros Oriental, after being sworn in accordance
with law, do hereby depose and state, that:

1. I was duly issued a non-professional driver’s license by the Land

Transportation Office (LTO) sometime on May 2018;

2. I kept the said license in my wallet. Recently, while I was about to

present it for debit card application, it was no longer there;

3. Despite diligent search and efforts to locate said driver’s license, I

could not find it such that I now believe that it is now lost and
beyond recovery;

4.  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 ____day
of July 2018, at Dumaguete City, Philippines.

MARVILIE M. SERNA
Affiant

SUBSCRIBED AND SWORN to before me this ____ day of July

2018, the affiant exhibiting her competent evidence of identify as above
indicated. Known to and to me known to be the person who executed the
foregoing instrument and she acknowledged to me that the same is her
free act and deed.
WITNESS MY HAND AND SEAL on the date first above-written.

Doc. No. ____.

Page No. ____.
Book No. ____.
Series of 2018.