REPUBLIC OF THE PHILIPPINES)

PROVINCE OF LAGUNA)
MUNICIPALITY OF CALAUAN ) S. S.

AFFIDAVIT OF LOSS

I, MELCHOR TABAYAG GALANG, single, Filipino, of legal age, and with

postal address at Brgy. San Isidro, Calauan, Laguna, after having duly sworn to in
accordance with law, do hereby depose and state:

1. That I am a duly-licensed Professional driver in accordance with pertinent LAND

TRANSPORTATION LAWS, RULES AND REGULATIONS issued by LAND
TRANSPORTATION OFFICE;

2. That four (4) days ago, said Driver's License was misplaced and got lost;

3. That despite diligent search and efforts to locate my Driver's License, I could not
find the same such that I now have reasons to believe that it is now lost and can’t
be recover;

4. That said Driver's License has not been confiscated by the LTO, Police or other
Traffic Enforcers for any traffic violation;

5. As such, I am executing this Affidavit of Loss to attest to the truth of the

foregoing and to support my application for the issuance of a new Driver's
License, in lieu of the one that was lost.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 24th day of

October 2019 at Calauan, Laguna.

MELCHOR TABAYAG GALANG

Affiant
CCI2018 11330844

SUBSCRIBED AND SWORN to before me a Notary Public for the Municipality of

Calauan, Bay, Los Banos and in the City of Calamba Laguna with office address at 2/F,
Villaran Building, Alvela St., Brgy. Kanluran Calauan Laguna, this 24 th day of October
2019 personally appeared the above named affiant showing to me his ID and avows
under penalty of law to the whole truth of the contents thereof.

ATTY. ALDRIN P. ALIMBUYOG

NOTARY PUBLIC
2F, Villaran Building, Alvela St. Brgy. Kanluran,
Calauan,Laguna
Roll. No. 73376
Doc. No. _______ IBP. 088585/LAGUNA
Page No. _______ PTR No. 7391498 /07-09-19 / Calauan, Laguna
Book No._______ MCLE: Newly admitted to the BAR
Series of 2019 Email Address; aldrinalimbuyog1@gmail.com
Cellular Phone No. 09565207359