REPUBLIC OF THE PHILIPPINES )

PROVINCE OF CEBU ) S.S.

MUNICIPALITY OF MINGLANILLA )

AFFIDAVIT OF LOSS

I, ANTONIO BLANCO , Filipino, of legal age, married, and a resident of,

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

That I am a holder of a Professional Driver’s License, issued by the LTO at

Talisay City, Cebu;

That sometime last week, my wallet containing said Professional driver’s license
was lost;

That said Professional Driver’s License was not confiscated by any authorities;

That said Professional Driver’s License could not anymore be found

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

That this affidavit is executed to be able to transact business with LTO, Talisay
City for the purpose of securing another Professional Driver’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 belief 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 21 s t day of June 2010,
in the Municipality of Minglanilla, Province of Cebu, Philippines.

ANTONIO BLANCO
Affiant
CTC No. 20579683
Issued on 06/21/10
At Minglanilla Cebu

SUBSCRIBED AND SWORN TO BEFORE ME , in the Municipality of

Minglanilla, Province of Cebu, this 21 s t day of June 2010. Affiant showing his CTC No.,
date and place of issue as indicated above below her name and signature.

Doc No.___________;
Page No.__________;
Book No.__________;
Series of 2010.