REPUBLIC OF THE PHILIPPINES)

MATAASNAKAHOY, BATANGAS ) S.S.

AFFIDAVIT OF LOSS
I, AGNES GAY M. REYMUNDE, of legal age, Filipino, and a resident of 9006 181
Julio St. Fernando Airbase Lipa City, Batangas, Philippines, after having been sworn to in
accordance with law hereby depose and state that:

1. I am the owner of a Non - Professional Driver's License issued by the Land

Transportation Authority (LTO) with License No. D01-18-008522.

2. That I placed my said Driver’s License inside my house;

3. That on April 23, 2023, I was at home looking for my Driver’s License and
realized it was misplaced and/or went missing;

4. That I took diligent search and efforts to locate my Driver’s License, but I could
not find the same, hence, I believe it is now beyond recovery;

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

statement, and to request for a replacement of my Driver’s License and for
whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 1 st day of May 2023 at
Mataasnakahoy, Batangas, Philippines.

AGNES GAY M. REYMUNDE

Affiant

SUBSCRIBED AND SWORN to before me this 1 st day of May, 2023 in

Mataasnakahoy, Batangas, Philippines, Affiant exhibited to his competent evidence of
identity as ____________________________.

Notary Public

Doc. No 370;
Page No. 75;
Book No. II;
Series of 2023.