Republic of the Philippines)

Angeles City ) S.S.

x---------x
AFFIDAVIT OF LOSS
I, Jerome Emiliani C. Ramirez, Filipino, of legal age, , and with residence at
Babo Sacan Porac Pampanga, 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 C10-11-008689 which is valid until 2022-02-08;

That sometime last week, said Driver's License was misplaced and got lost.

That despite diligent search and efforts to locate my Temporary Driver's

License, I could not find the same such that I now believe that it is now lost
beyond recovery;

That said Temporary 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 2nd day of

October, 2017, the affiant being personally known to the notary public, at
Angeles City, Philippines.

AFFIANT

Doc No. ___

Page No. ___
Book No. ___
Series of 2017