Republic of the Philippines}

Butuan City } S.s.

AFFIDAVIT OF LOSS

I, JOHN ALGORE VISMANOS AQUINO, Filipino, of legal

age, and a resident of Purok 1, Bag-ong Argao, Molave, Zamboanga
del Sur, Philippines, after having been sworn to in accordance with
law, do hereby depose and state that:

1. I am a holder of a Driver’s License;

2. However, on December 17, 2017 while riding the bus from

Cagayan de Oro to Butuan City, I lost my Driver’s License;

3. I tried to obtain and/or recover my Driver’s License to the

proper authorities in the hope that somebody might have
surrendered the same to them but to no avail, my efforts
remained futile;

4. My Driver’s License was not confiscated by any Philippine

authority and/or agency for any purpose whatsoever;

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

foregoing and for whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this

__________________ in Butuan City, Philippines.

JOHN ALGORE VISMANOS AQUINO

Affiant

SUBSCRIBED AND SWORN TO before me this

________________ in Butuan City, Philippines, the affiant exhibiting to
me his __________________ issued on ________ at ____________.

Doc. No. ____;

Page No. ____;
Book No. ____;
Series of 2017