Republic Of Philippines )

LIPA CITY ) SS.

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AFFIDAVIT OF LOSS

I, JYREX ROWY BALITON, Filipino, with postal address at Pangsangahan,

San Francisco, Aurora, Quezon, after having been duly sworn in accordance with law,
hereby depose and say:

1. I am a duly licensed driver in accordance with pertinent Land

Transportation laws, rules and regulations, and was issued a corresponding
Professional Driver's License No. D09-16-000542.

2. Sometime in December 2018, said driver's license was misplaced and got lost;
3. Efforts were exerted to locate said driver's license, but in spite of diligent
search, it could not be found and the same is now beyond recovery;
4. Said Driver's License has not been confiscated by the LTO, Police or other
Traffic Enforcers for any traffic violation;
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 a new Non -
Professional Driver's License, in lieu of the one that was lost;

IN WITNESS WHEREOF, I have hereunto affixed my signature this day of

______________ at Lipa City, Philippines.

JYREX ROWY BALITON

Affiant

SUBSCRIBED AND SWORN before me this day of _________________ at

Lipa City Philippines.

Doc.No.___;
Page No.___;
Book No.___;
Series of _____ .