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REPUBLIC OF THE PHILIPPINES )

PROVINCE OF CEBU ) S.S.


MUNICIPALITY OF MINGLANILLA )

AFFIDAVIT OF LOSS

I, BERNARDO C. MANAYON, Filipino, of legal age, single, and presently


residing at Cuanos, Minglanilla, Cebu, after being duly sworn to in accordance
with law, hereby depose and say:

That I am a holder of a Conductor’s License issued by the LTO, Cebu City;

That, last October 28, 2007, while on board a public utility vehicle, my
wallet, where said Professional driver’s license was placed, was lost;

That said Conductor’s License was not confiscated by any lawful


authorities;

That said Conductor’s License could not anymore be found notwithstanding


my diligent efforts to locate the same, hence considered as lost for al legal intents
and purposes;

That this affidavit is executed to attest to the foregoing facts, and to secure
another Conductor’s License, in lieu of the lost one, and for whatever legal
purpose it may serve;

That the contents of this affidavit are true and correct according to my best
knowledge and that the same is executed without any fraudulent intention against
any person, natural or juridical.

IN WITNESS WHEREOF, I have hereunto set my hand this 7 t h day of


November 2007, in the Municipality of Minglanilla, Province of Cebu, Philippines.

BERNARDO C. MANAYON
Affiant
CTC No. 05920967
Issued on November 7, 2007
At Minglanilla, Cebu

SUBSCRIBED AND SWORN TO BEFORE ME, in the Municipality of Minglanilla,


Province of Cebu, this 7 t h day of November 2007 by BERNARDO C. MANAYON ,
personally known to me, who is the same person who personally signed before me the
foregoing affidavit and acknowledged that he executed the same.

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