REPUBLIC OF THE PHILIPPINES )

CITY OF MANILA ) S.S.

x----------------------------------------------x

AFFIDAVIT OF LOSS

I, Shirley Marie Dela Cruz Cada, of legal age, Filipino, married and a
resident of Unit 521, KB Arizona Towers, P. Campa St., Sampaloc, Manila,
after having been duly sworn to in accordance with law, depose and state
THAT:

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

Transportation laws, rules and regulations, and was issued a
corresponding Non-Professional Drivers License with number N04-
07-001234 which is valid until November 26, 2017;

2. That sometime on January 23, 2017, said drivers license was

misplaced and got lost when I had disposed of all the unnecessary
receipts and calling cards in my wallet while I was at Starbucks
Sampaloc Branch doing financial auditing of my expenses;

3. That upon checking of the contents of my wallet last January 24,

2017, I noticed that my Drivers License was missing;

4. That I went back to Starbucks Sampaloc Branch and inquired if they

had recovered the said Drivers License, but they answered in the
negative. I even requested the Store Manager to help me locate the
said license and to give me a feedback as soon as possible. A week
after their diligent search, they reported that they were not able to
recover the said license;

5. That I went on to check my car and my room for a couple of times in

the hope of recovering the said drivers license but the search was not
successful;

6. That diligent efforts were exerted to locate said drivers license, but
despite my diligent search upon the said license, it could not be found
and the same is now beyond recovery;

7. That the said Drivers License has not been confiscated by the LTO,
Police or other Traffic Enforcers for any traffic violation;
 8. 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 Drivers License, in lieu of the one that was lost;

IN WITNESS WHEREOF, I have hereunto set my hand this

February 14, 2017 in Sampaloc, Manila City, Philippines.

_______________________
Affiant
SSS ID No. 33-8357734

SUBSCRIBED AND SWORN TO before me this 14 February 2017 in

Sampaloc, Manila, Philippines, affiant exhibiting to me his/her competent
evidence of identity by way of SSS ID No. 33-8357734 issued at SSS Main
Branch, East Avenue Branch, Quezon City.

Doc No. 027;

Page No. 015;
Book No. 002;
Series of 2017.