Republic of the Philippines)

City of Cagayan de Oro…..) ss.

AFFIDAVIT OF LOSS

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

________________________, Philippines, after having been duly sworn to
in accordance with law do hereby depose and say:

1. That on ________________, I had my last session of my driving

lessons at __________ Driving School and I presented my Student
Driver’s Permit to my instructor as part of the school’s protocol;

2. That when I reached home, I noticed that my student permit

issued by LTO- Region X was no longer inside my bag and
thought that it may have fell-off after the session;

3. That I contacted the school and exerted efforts to locate my

Student Permit but such efforts have been proven futile. That I
could no longer find it and now I consider it now as lost beyond
recovery;

4. That I execute this affidavit for the purpose of getting a duplicate

copy of my Student Driver’s Permit, attest to the truth of the
foregoing facts and for whatever legal purpose that this may serve
best.

IN WITNESS WHEREOF, I hereunto affix my signature this ___

day of ____________ 2018 at Cagayan de Oro City.

____________________________________
Affiant

SUBSCRIBED AND SWORN to before me this ___ day of January

2018 at Cagayan de Oro City by __________________________, with
Philippine Passport No. _______________, personally known to me to be
the same person who executed this Affidavit.

I HEREBY CERTIFY that I have personally examined the affiant

and am satisfied that she has read and understood her affidavit the
contents of which she has personal knowledge.