Republic of the Philippines )

City of Calbayog, Samar ) s.s.

AFFIDAVIT OF LOSS
(Re: Driver’s License)

I, GEORGE MICHAEL TOCAYON FORTUNA, Filipino, 33 years

of age, with common-law partner, and presently residing at Barangay
Hamorawon, Calbayog City, Samar, Philippines, after having been duly
sworn to in accordance with law, hereby depose and state, that--

1. I am a holder of a Professional Driver’s License duly issued

by the Land Transportation Office (LTO) of Calbayog City, with
License Number H01-14-002539;

2. Just recently, my wallet where the said license card including

my other identification cards, was lost, without my knowledge;

3. The moment I learned about it, I exerted diligent efforts to

locate the same, but to no avail;

4. The said Driver’s License was not confiscated nor apprehended

by proper authorities in any violation of law or ordinance or
rules;

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

foregoing facts and to support my application for the issuance
of a new Driver’s License Card and for whatever legal purpose
this may serve;

IN WITNESS WHEREOF, I have hereunto set my hand this 10th

day of October 2019, at Calbayog City, Samar, Philippines.

GEORGE MICHAEL TOCAYON FORTUNA

Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, 10th day of October

2019, at Calbayog City, Samar, Philippines.

ATTY. ALJUN B. DIAZ

Public Attorney I
Pursuant to RA 9406
Republic of the Philippines )
City of Calbayog ) s.s.

AFFIDAVIT OF LOSS
(Re: Driver’s License)

I, ARNOLD PALLONES VELASCO, Filipino, 30 years of

age, with common-law partner and presently a
resident of Barangay Malopalo, Calbayog City, Samar,
Philippines, after having been duly sworn to in accordance
with law, hereby depose and state, that--

1. I am a holder of a Professional Driver’s License duly

issued by the Land Transportation Office (LTO) of
Calbayog City, with License Number H0619002165;

2. Just recently, my wallet where the said license card

including my other identification cards, was lost,
without my knowledge;

3. The moment I learned about it, I exerted diligent

efforts to locate the same, but to no avail;

4. The said Driver’s License was not confiscated nor

apprehended by proper authorities in any violation of
law or ordinance or rules;

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

of the foregoing facts and to support my application
for the issuance of a new Driver’s License Card and
for whatever legal purpose this may serve;

IN WITNESS WHEREOF, I have hereunto set my hand this 20th

day of May 2019, at Calbayog City, Samar, Philippines.

ARNOLD PALLONES VELASCO

Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, 20th day of May 2019,

at Calbayog City, Samar, Philippines.

ATTY. LOUIE O. SAJONIA

Public Attorney II
Pursuant to RA 9406