REPUBLIC OF THE PHILIPPINES)

PROVINCE OF ZAMBALES ) S.S.

MUNICIPALITY OF PALAUIG

AFFIDAVIT OF LOSS

I, SAMUEL EBUENG EGALLA, of legal age, Filipino citizen, and a

resident Purok 2, Nagbunga, Castillejos, Zambales, under oath, hereby
depose and state that:

1. I am a holder of LTO Driver’s license;

2. Sometime in April 2024, somewhere in Iba, Zambales, I lost my
wallet containing all my Identification Cards including my LTO
Driver’s License
3.I have exerted earnest and diligent efforts to find and locate my
lost LTO Driver’s License, but to no avail.
4. I have no other recourse but to declare that the
4. I am executing this affidavit to attest to the truth of all the
foregoing and in order to support my application to replace and
renew my Philippine Passport.

IN WITNESS WHEREOF, I have hereunto set my hand this 31st of March

2024 at the Municipality of Iba, Zambales, Philippines.

Arnel Mendoza Balanay

Affiant

UBSCRIBED AND
SWORN to before me, this
_ in
with affiant exhibiting his
PRC ID No. _
issue
SUBSCRIBED AND SWORN to before me, this 31st of March 2024 at Iba,
Zambales, Affiant presenting to me his Senior Citizen’s ID with ID no. 18805
issued at Palauig, Zambales.

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Series of 2024