Republic of the Philippines)

City of Z a m b o a n g a ) S.S.
X - - - - - - - - - - - - - - - - - - X

AFFIDAVIT OF LOSS DRIVER’S LICENSE

I, PASCUALITO IBAÑEZ CONCEPCION, married, legal age, Filipino

and resident of Sat. Maria, Zamboanga City, Philippines, after being
duly sworn to in accordance with law, hereby depose and state:

1. That I was issued a Professional Driver’s License with No.

J04-91-035629 in accordance with pertinent LAND TRANSPORTATION
LAWS, RULES AND REGULATIONS;

2. That lately I discovered the aforementioned 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 recovered;

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 set my hand this __ day of

December, 2019 at Zamboanga City, Philippines.

PASCUALITO IBAÑEZ CONCEPCION

AFFIANT

SUBSCRIBED AND SWORN TO BEFORE ME on this December ____, 2019 at

Zamboanga City. Affiant having exhibited to me his __________ID. Card
bearing No. ________________ and valid until _________________ issued
in Zamboanga City.

Doc. No. _____

Page No. _____
Book No. _____
Series of 2019.