REPUBLIC OF THE PHILIPPINES )

Mandaue City ) S.S.

AFFIDAVIT OF LOSS

I, JOSEMARIA YAP YLAYA III, Filipino, of legal age, single, and a resident
of 888 A.S. Fortuna St., Banilad, Mandaue City, after having been duly sworn in
accordance with law, hereby depose and say:

1. That I am a holder of a Driver’s License Official Receipt valid as

temporary driver’s license issued by the Land Transportation Office
(LTO) of Mandaue City since at the time I applied for renewal, the LTO
had no cards available;

2. That I forgot the Official Receipt No. contained in the said Official
Receipt serving as temporary driver’s license;

3. That sometime on September 25, 2019, I lost my wallet which

contained the said Official Receipt;

4. That despite diligent search and efforts to locate my wallet which

contained the said Driver’s License Official Receipt valid as temporary
driver’s license, such has not been found and it is my belief that it is
now lost beyond recovery;

5. That said Driver’s License Official Receipt valid as temporary driver’s

license was not confiscated by the authorities for any reason. Neither
did I violate any rules and regulations;

6. That I am executing this affidavit to attest to the truth of the foregoing

facts and for whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 26th

day of September 2019 at Mandaue City, Philippines.

JOSEMARIA YAP YLAYA III

Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, a notary public in

Mandaue City this 26th day of September 2019 at Mandaue City, Philippines.
Affiant personally came and appeared with his Passport ID # P0801444B valid
until February 22, 2029, bearing his photograph and signature, known to me as
the same person who personally signed the foregoing instrument before me and
avowed under penalty of law to the whole truth of the contents of said instrument.

Doc. No. 274;

Page No. 56;
Book No. V
Series of 2019.