REPUBLIC OF THE PHILIPPINES )

CITY OF PARAÑAQUE ) S.S.

AFFIDAVIT OF LOSS

I, Reneth Enoja Parao, of legal age, Filipino, with residence and postal address at
AB 113 Galleria de Magallanes, Lapu-lapu Avenue, Magallanes, Makati City, after
having duly sworn in accordance with law, hereby 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;

2. Sometime in September of 2016, said driver’s license was misplaced and got
lost;

3. Despite diligent efforts exerted, I could no longer locate, find or recover the
said Driver’s License, and to the best of my knowledge, the same is truly lost;

4. The said Driver’s License has not been confiscated by any officer of the law or
the issuing office or agency due to any violation of law, statute, order, rule or
regulation;

5. I am executing this affidavit to attest to the truth of the foregoing statements

and to support my application for the issuance of a new Non-Professional
Driver’s License, in lieu of the one that was lost.

FURTHER AFFIANT SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto set my hand this ________________ at

Parañaque City, Philippines.

________________________
Reneth Enoja Parao

SUBSCRIBED AND SWORN to before me this ____________ of September 2016

at Parañaque City, Philippines, affiant appearing and is personally known to me to be
the same person who executed this affidavit being the kasambahay of my sister since
2006.

NOTARY PUBLIC

Doc No. __________;

Page No. __________;
Book No. __________;
Series of 2016.