REPUBLIC OF THE PHILIPINES )

PROVINCE OF MASBATE ) S.S.

AFFIDAVIT OF LOSS

I, RONNELLE NICO D. BAITA, of legal age, Filipino, single and with

residence address at Barangay Fabrica, Mobo, Masbate, subscribing under oath,
depose and state:

1. I am a holder and/or possessor of a Non-Professional Driver’s

License which is still valid that was issued by the Land Transportation Office-
Masbate.

2. I used to place said Driver’s License in my wallet.

3. On 10 December 2019, I discovered that said Driver’s License was

no longer in my wallet where I kept it.

4. Diligent efforts to locate the same had proved futile.

5. I am executing this affidavit to attest to the truth of the foregoing

and for whatever legal purpose this may serve.

Affiant further sayeth naught.

Masbate City, Masbate, 18 December 2019.

RONNELLE NICO D. BAITA

Affiant

SUBSCRIBED AND SWORN to before me this 18th day of December

2019, in Masbate City, Masbate, by affiant who is personally known to me.

Doc. No._____;
Page No._____;
Book No._____;
Series of 2019.