REPUBLIC OF THE PHILIPPINES )

CITY OF TAGBILARAN ) S.S.

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AFFIDAVIT OF LOSS

I, ARMANDO U. LURA, of legal age, a resident of Abaca, Mabini, Bohol, after having
been duly sworn in accordance with law hereby depose and state that:

1. I am the owner of a Driver’s License issued by the Land Transportation Office –

Tagbilaran Branch;

2. Sometime last July 2019, I had went home to my hometown in Mabini, Bohol, upon my
return to Tagbilaran City, I noticed that I had lost the said Driver’s License;

3. I had gone through all my things and had searched all over my house, however, despite
my utmost diligent effort and meticulous endeavor, I was unable to recover the said
Driver’s License;

4. I am executing this affidavit to attest to the truthfulness of the foregoing and for whatever
purpose it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature on this 17th day of September
2019, at Tagbilaran City.

ARMANDO U. LURA
Affiant

SUBSCRIBED and SWORN to before me this 17th day of September 2019, at Tagbilaran City. I
hereby certify that I have personally examined the above-named affiant and that I am satisfied that
the foregoing statements were given by him voluntarily and of his own free will.

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