REPUBLIC OF THE PHILIPPINES)

SAN JUAN, METRO MANILA ) S.S.

A F F I D A V I T

KNOW ALL MEN BY THESE PRESENTS:

THAT I, RENE C. CORPUZ, of legal age, Filipino, married, with residential

address at 115 J. Basa corner Lope K. Santos, Barangay Pedro Cruz, City of San Juan,
Metro Manila, after being duly sworn to in accordance with law, depose and say:

1. That I am the owner of Non-Professional Driver’s License No. 01-86-

041693 issued by the Land Transportation Office (LTO) and valid up to
2024 June 24;

2. That the said Non-Professional Driver’s License has been lost while in my
possession and could not be found despite diligent search to locate the same;
and

3. That this affidavit is being executed for the purpose of requesting the Land
Transportation Office to issue a replacement Non-Professional Driver’s
License in lieu of the lost license thereof.

IN WITNESS WHEREOF, I have signed this affidavit on this _____ day of

January, 2024 at San Juan City, Metro Manila.

RENE C. CORPUZ
Affiant

SUBSCRIBED AND SWORN TO before me this ____ day of January, 2024,

affiant exhibiting his Senior Citizen ID No. 6546 issued on August 3, 2007 at San Juan
City.

NOTARY PUBLIC

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2023.