Republic of the Philippines )

Province of La Union )S.S.

Municipality of Naguilian )
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AFFIDAVIT OF LOSS
I, BENNY R. BARNACHEA, Filipino, of legal age, married and a
resident of Brgy. Suguidan Sur, Naguilian, La Union, Philippines, after being
duly sworn to in accordance with law, hereby depose and state:

1. 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;

2. That I kept such driver’s license with me for safekeeping;

3. That sometime on 2012, while I was on board my tricycle on my

way home from Naguilian town proper, said Driver’s License must
have dropped from where I kept it and got lost;

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

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

5. That said Driver's License has not been confiscated by the LTO,
Police or other Traffic Enforcers for any traffic violation;

6. 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 the
above-mentioned Driver’s License in lieu of the one that was lost.

IN WITNESS WHEREOF, I have hereunto set my hand this 10 th day of

January 2019 at Naguilian, La Union, Philippines.

BENNY R. BARNACHEA
Affiant
Voter’s ID # 3311-0119A-I1274BRB10000

SUBSCRIBED AND SWORN to before me this 10th day of January 2019

at Naguilian, La Union, Philippines.