Republic of the Philippines)

City of Bais........................) S.S.

AFFIDAVIT OF LOSS

I, CORNELIO S. BALANA, JR., of legal age, Filipino, married and a

resident of Barangay Tamogong, Bais City, Negros Oriental, after having sworn to
in accordance with law do hereby depose and state:

That I am a bona fide holder of Professional Driver’s License issued by

LTO, Dumaguete City:

That the Temporary Driver’s License was lost sometime on August 27, 2019
while travelling from Cebu City to Bais City, Negros Oriental;

That diligent efforts were exerted to locate said Temporary Driver’s License
but the same could no longer be recovered so I considered it as lost and beyond
recovery;

That said Driver’s License was not confiscated by any apprehending

authorities;

I am executing this Affidavit to attest the truthfulness of the foregoing fact

and forever legal purpose it may serve best.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 30th

day of August 2019 at Bais City, Philippines.

CORNELIO S. BALANA, JR.

Affiant
VIN: 4604-0174-H2581CSB10000

SUBSCRIBED AND SWORN to before me 30th day of August 2019 at Bais

City, Philippines.
Republic of the Philippines)
City of Bais........................) S.S.

AFFIDAVIT OF LOSS

I, JOSELITO S. TAÑO, of legal age, Filipino, married and a resident of

Bolisong, Manjuyod, Negros Oriental, Philippines, after having sworn to in
accordance with law do hereby depose and state:

That I am a bonafide holder of a Conductor’s License issued by the Land

Transportation Office, (LTO), Bais City;

That the said Conductor’s License was lost on March 23, 2018 in Bais
City;

That despite diligent effort to locate said license the same could no longer be
recovered so I considered it as lost and beyond recovery;

That said license was not confiscated by any apprehending authorities for
violations of any traffic rules and regulations;

I am executing this Affidavit to attest the truthfulness of the foregoing fact

and forever legal purpose it may serve best.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 21st

day of May, 2018 at Bais City, Philippines.

JOSELITO S. TAÑO
Affiant

SUBSCRIBED AND SWORN to before me this 21st day of May, 2018 at

Bais City, Philippines.

/rlg
Republic of the Philippines)
City of Bais......................) S.s.

AFFIDAVIT OF LOSS

I, _____________________________, of legal age, Filipino and a resident

of __________________________ Negros Oriental, Philippines, after having
sworn to in accordance with law do hereby depose and state:

That I am a bonafide holder of ___________________________;

Issued to me by _______________________________________;

That the said document lost sometime on January 6, 2018;

That the said document was lost sometime on______________________;

That despite diligent effort to locate said document the same could no longer
be recovered so I considered it as lost and beyond recovery;

I am executing this Affidavit to attest the truthfulness of the foregoing fact

and forever legal purpose it may serve best.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

______ day of _______________, 2018 at Bais City, Philippines.

__________________
Affiant

SUBSCRIBED AND SWORN to before me this _______ day of ________,

2018 at Bais City, Philippines.

/rlg