REPUBLIC OF THE PHILIPPINES)

City of Santiago ) S.S.

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AFFIDAVIT OF LOSS

I, RODANTE B. SOLA, Filipino, of legal age, married, and a resident of Mabini,

Santiago City, Philippines, after being duly sworn to in accordance with law, hereby depose and
state:

That I am a tricycle driver and at the same time a duly-licensed driver in accordance
with pertinent Land Transportation laws, rules and regulations, and was issued a
corresponding Driver's License which is valid until Year 2011;

That on April 05, 2010 at around 6:30 in the morning, while I was taking a bath in the
comfort room of our house located at Mabini, Santiago City, my wallet which I
usually place at the back of our front door and my cell phone were taken away by an
unidentified person;

That inside the said wallet are my Driver's License issued by LTO Santiago City Branch,
SSS I.D., Pawn Ticket issued by ETC Pawnshop, sum of money amounting to
P3,000.00 and other pertinent documents;

That despite diligent search and efforts to locate the said wallet and my cell phone, I
could not find them such that I now believe that they are now lost beyond recovery;

That my Driver's License has not been confiscated by the LTO, Police or other Traffic
Enforcers for any traffic violation;

As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing facts
and to support my application for the issuance of a new Driver's License, SSS I.D.,
and duplicate copy of Pawn Ticket in lieu of the ones that were lost.

IN WITNESS WHEREOF, I have hereunto set my hand this 5 th day of April, 2010 at
Santiago City, Philippines.

RODANTE B. SOLA
Affiant

SUBSCRIBED AND SWORN to before me, this 5th day of April, 2010, by the Affiant
who is personally known to me and who exhibited his Community Tax Certificate No. issued at
Santiago City on 2010.

Doc. No. ______;

Page No. ______;
Book No.______;
Series of 2010.