REPUBLIC OF THE PHILIPPINES )

CITY OF BATANGAS ) S.S.

AFFIDAVIT OF LOSS

I, Jenny Cruz, of legal age, Filipino, single, and a resident of Batangas City, after having been duly sworn to in accordance with
law, depose and state THAT:

1. I am a duly licensed driver in accordance with pertinent Land Transportation laws, rules and regulations, and was issued a
corresponding (Non) Professional Driver's License with number D-00012-0003 which is valid until December 12, 2024;

2. Sometime on February 1, 2024, said driver's license was misplaced and got lost;

3. Efforts were exerted to locate said driver's license, but in spite of diligent search, it could not be found and the same is now
beyond recovery;

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

5. As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing and to support my application for the
issuance of a new (Non) Professional Driver's License, in lieu of the one that was lost;

IN WITNESS WHEREOF, I have hereunto set my hand this 13th day of February 2024, in the City of Batangas, Philippines.

___________________

Jenny Cruz

Affiant

Passport ID No. P000000A

SUBSCRIBED AND SWORN to before me this 13th day of February in Batangas City, Philippines, affiant exhibiting to me her
competent evidence of identity by way of Passport No. P000000A issued on June 27, 2023 at Department of Foreign Affairs Manila.

WITNESS MY HAND AND NOTARIAL SEAL on the day, year and place first above-written.

Doc No. ______ Atty.

Page No. _____ Notary Public for Batangas City

Book No. _____ Commission Serial No. _____

Series of 2024 Until December 31, 2025

Office Address ______

Roll of Attorney No. ___

PTR No. ____/ Issued at ___ on ______

IBP No. _____/ date/ place issued)