Republic of the Philippines)

C I T Y O F D A V A O ) SS.
x- - - - - - - - - - - - - - - - - --x

AFFIDAVIT OF LOSS

I, MACHIAVELI A. SERAPIO of legal age, Filipino, single, and a resident of

Davao City, after being duly sworn in accordance with law hereby depose and say
that:

1. I am a holder of a Drivers License duly issued by the Land Transportation

Office as well as two ATM Cards duly issued to me by Bank of the
Philippines Islands (BPI), East-West Bank, and China Trust Bank,
respectively;

2. The abovementioned Drivers License and ATM Cards were in my

possession from the time of their issue until 21 June 2014 when all were
inadvertently lost in my possession when I lost the bag and the walket
therein wherein such were contained;

3. Notwithstanding diligent efforts exerted to locate them, the same were not
recovered and hence considered lost for all intents and purposes;

4. I attest to the truth of the foregoing circumstances and that I am executing

this affidavit to apprise the LTO, BPI, East West Bank and China Trust Bank
of such fact of loss and for the purpose of being issued a new Drivers
License in lieu of the lost one and for its renewal, if proper, as well as new
ATM Cards in lieu of the lost ones as described above and for whatever
other legal purposes this affidavit may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

_______________ at Davao City, Philippines.

MACHIAVELI A. SERAPIO
Affiant
______________________

SUBSCRIBED and sworn to before me, in the City of Davao, this

______________ 2017.

Doc. No. ____

Page No. ____
Book No. ____
Series of 2017.