Republic of the Philippines )

City of Cotabato ) S.s

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

AFFIDAVIT OF LOSS

I, Tahara Koji, of legal age, Filipino, married, and a resident of Tacunan,

Davao City, Philippines, after having been duly sworn in accordance with law,
hereby depose and state:

That I am the lawful holder a Philippines Non-Professional Driver’s

License bearing ID No. U03-22-001302 issued by the BARMM Land
Transportation Office;

That recently I had tried to look for the said Driver’s License could not be
found;

That despite diligent search and efforts to locate the said Driver’s License,
I could not find the same such that I now believe that it is now lost beyond
recovery;

That the said Driver’s License has not been encumbered, sold, pledged,
assigned, alienated, transferred, donated, or given as a collateral for any debt or
obligation to or in favor of any person or entity; and

That I am executing this Affidavit to attest to the veracity of the foregoing

facts and for whatever legal purpose it may serve under the law.

IN WITNESS WHEREOF, I have hereunto set my hand this January 19,

2023 at Cotabato City, Philippines.

TAHARA KOJI
Affiant

SUBSCRIBED AND SWORN to before me this 19 th day of January, 2022 in

Cotabato City, affiants exhibiting to me her valid proof of identification.

Doc. No. 397

Page No. 80
Book No. VI
Series of 2023