Republic of the Philippines) Province of _______________) S.S.

x-----------------------x

-Affidavit of Loss Drivers License I, _____________, Filipino, of legal age, (single / married / widow), and with residence at _____________, Philippines, after being duly sworn to in accordance with law, hereby depose and state: That I am a duly-licensed driver in accordance with pertinent Land Transportation laws, rules and regulations, and was issued a corresponding Driver's License with number _____________ which is valid until _____________; That sometime last week, said Driver's License was misplaced and got lost; That despite diligent search and efforts to locate my Driver's License, I could not find the same such that I now believe that it is now lost beyond recovery; That said Driver's License has not been confiscated by the LTO, Police or other Traffic Enforcers for any traffic violation; 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 _____________ at _____________, Philippines.

AFFIANT

(JURAT)

Republic of the Philippines) Province of ___________) x-----------------------x AFFIDAVIT OF LOSS I, _____________, Filipino, of legal age, (single / married / widow), and a resident of _____________, Philippines, after being duly sworn to in accordance with law, hereby depose and state: That I am an employee of _____________ at _____________, Philippines and at the same time a duly-licensed driver; That on _____________ at around ________, while I was at the _____________ at _____________, I lost my wallet which I usually place in my back pocket; That inside the said wallet are my Driver's License and ATM Card issued by _____________ Bank, _____________ Branch; That despite diligent search and efforts to locate the said wallet and my Driver's License and my ATM Card, I could not find them such that I now believe that they are now lost beyond recovery; That my Driver's License has not been confiscated by the LTO, Police or other Traffic Enforcers for any traffic violation; 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 and a new ATM Card, in lieu of the ones that were lost. IN WITNESS WHEREOF, I have hereunto set my hand this _____________ at _____________, Philippines. Affiant (JURAT)

Republic of the Philippines) Province of ____________________)S.S. City/Municipality of _____________) x---------------x AFFIDAVIT OF LOSS I, RODOLFO FRANCISCO, Filipino, of legal age, married, and a resident of Road 9 Brgy. Bagong Silangan, Quezon City, Philippines, after being duly sworn in accordance with law, depose and state: That sometime on _____________, I pawned my _____________ with Agencia _____________ located at Bagong Silangan, Quezon City and for which I was issued Pawn Tickets / Receipt No. _____________. That sometime on _____________, my wallet that contains the said Pawn Ticket was misplaced and got lost. That despite diligent search and efforts to locate the said wallet and pawn ticket, I could not find the same such that I now believe that they are now lost beyond recovery. As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing facts. IN WITNESS WHEREOF, I have hereunto set my hand this _____________ at _____________, Philippines. Affiant (JURAT)

REPUBLIC OF THE PHILIPPINES ) Province/City__________________ ) SS. AFFIDAVIT OF LOSS I, ________(name)_______, of legal age and residing/with _________________________________________, under oath, state: 1. THAT on ______(date)_____ at _________(describe how loss occurred)___________; Example: 1. THAT on 28 February 2005 while riding on a jeepney on my way home, my wallet was pick-pocketed without my knowledge; 2. Example: 2. THAT my wallet contained my school ID, my Drivers License and some money bills; THAT ___________________(describe the particulars of what was lost)_____; address at while

_________(place)_________

3. THAT I exerted diligent efforts to locate _____(the thing lost)____ or but to no avail and I therefore considered the same as lost and can no longer be found; Example: 3. THAT I exerted diligence efforts to locate my wallet or identify the culprit but to no avail and I therefore considered the same as lost and cannot be found; 4. THAT I am executing this Affidavit to attest to the truth of the foregoing facts and to use the same for whatever legal purpose it may serve. IN WITNESS WHEREOF, I hereunto affix my signature this _______________ __________________. __________(name)________ Affiant SUBSCRIBED AND SWORN to before me this _______________ at __________________, Affiant exhibiting to me his Community Tax Certificate bearing No. ________________ issued at _________________ on ___________________________. at

Doc No. ________; Page No. _______ ; Book No. _______; Series of 2005. Wf00001