REPUBLIC OF THE PHILIPPINES )

MEYCAUAYAN CITY BULACAN ) S.S.

AFFIDAVIT OF LOSS

I, CLARISSE FAITH R. BELO, Filipino, of legal age, and a resident of No. 117
Everlasting St., Saluysoy, Meycauayan City, Bulacan, after being duly sworn to in
accordance with law, hereby depose and state that:

1. I am a holder of Driver’s License issued by the Philippine Land

Transportation Office (LTO);

2. Sometime in January 2018, I lost/ misplaced the said Driver’s License

somewhere in Canada;

3. Despite diligent efforts exerted to recover the same, the said driver’s
license can no longer be found and thus, considered lost for all legal purposes;

4. The said Driver’s License is not confiscated by any person in authority;

5. 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 replacement and/or
renewal of the said driver’s license.

IN WITNESS WHEREOF, I have hereunto set my hand this 13th day of June,
2018 at Meycauayan City, Bulacan, Philippines.

CLARISSE FAITH R. BELO

Affiant

SUBSCRIBED AND SWORN to before me this 13th day of June, 2018, affiant
satisfactorily proven to me her identity through her Passport ID No. EB802711, and
that she is the same person who personally signed before me the foregoing affidavit
and acknowledged that she executed the same.

Doc No. 333;

Page No. 68;
Book No. II;
Series of 2018.