REPUBLIC OF THE PHILIPPINES)

City of Marawi ) S.S.

AFFIDAVIT OF LOSS

I, AMENODIN MACALANDAP MAMUA of legal age, Filipino and a resident

of Barrio Salam, Marawi City after having been sworn in accordance with law, depose
and state:

1. I am the holder of a valid driver’s license issued by LTO;

2. Said driver’s license was lost;

3. That said driver’s license could not be located despite my diligent efforts to look
for it;

4. That I am executing this affidavit to attest to the truth of the foregoing and for the
purpose of securing another driver’s license.

IN WITNESS WHEREOF, I have hereunto set my hand this 9 th day of May

2017 in Marawi City.

Amenodin M. Mamua
Affiant

SUBSCRIBED AND SWORN TO before me this 9th day of May 2017 in

Marawi City, affiant having exhibited to me his TIN ID issued in Marawi City.

Doc. No. _____

Page No. _____
Book No. _____
Series of _____