REPUBLIC OF THE PHILIPPINES}

MUNICIPALITY OF PATEROS } S.S.

METRO MANILA }

AFFIDAVIT OF LOSS

I, LEO M. REBULLIDA, of legal age, Filipino and resident of 103 S.

Tuazon Street, Pateros, Metro Manila, under oath depose and say that –

1. That I am the authorized driver of that certain passenger tricycle

and holder of a Franchise No. 2023-1372 under the name Antonio
Rodrigo M. Garcia.

2. That the Original Copy of said Tricycle Franchise No. 2023-1372

has been in my possession and I am keeping the same on the
compartment of the tricycle.

3. However, when I am looking for the same to be used and to be

presented at the LTO Check Point, the aforesaid Tricycle
Franchise No. 2023-1372 cannot be found or located.

4. That I have searched the aforesaid Tricycle Franchise No. 2023-

1372 but to no avail.

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

foregoing for all legal intents and purposes.

IN WITNESS WHEREOF, I affixed my signature this April 29, 2024

at Pateros, Metro Manila.

LEO M. REBULLIDA
Affiant

SUBSCRIBED AND SWORN to before me this April 29, 2024 at

Pateros, Metro Manila with Affiant affixing her signature in my presence
and within my notarial jurisdiction.

Doc. No.______
Page No.______
Book No.______
Series of 2024