REPUBLIC OF THE PHILIPPINES )

CITY OF SAN FERNANDO

) S.S.
PROVINCE OF P A M P A N G A
)

AFFIDAVIT OF LOSS
I, RAMILLO L. SERAME, of legal age, married and with address at
No. 29 Agcano, Guimba, Nueva Ecija, after having been duly sworn to in
accordance with law hereby depose and state:
1.
That I was duly issued a professional drivers license by the
Land Transportation Office (LTO);
2.
That when I was issued said drivers license I kept the same
inside a pouch bag which I carry on a daily basis;
3.
That I rode a Victory Liner bus bound for San Fernando,
Pampanga from Cubao, Quezon City last November 21, 2015.
Unfortunately, upon alighting from the bus at the terminal in San
Fernando, Pampanga I left behind said pouch bag and only came to
realize the same upon reaching my destination in Sto. Tomas, Pampanga;
4.
I went back to the bus terminal hoping to recover my pouch
bag and the contents thereof incuding my drivers license, but the same
failed futile despite exertinfg diligent effort to look for the same. Hence,
said drivers license is now considered lost for all intents and purposes;
5.
That I executed this Affidavit to attest to the truth of all the
foregoing facts, to inform the LTO of the loss of my drivers license and for
whatever legal purposes it may serve.
IN WITNESS WHEREOF, I have hereunto affixed my signature
this 23rd day of November, 2015 at City of San Fernando, Pampanga,
Philippines.

RAMILLO L. SERAME
Affiant

SUBSCRIBED AND SWORN, to before me this 23rd day of

November, 2015 at the City of San Fernando, Pampanga, Philippines
affiant exhibiting to me his PNP Non-Commissioned Officer ID with No.
151280056 as competent evidence of his identity.