Affidavit of Loss DL

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Republic of the Philippines ) S.S.

Province of Bulacan )

AFFIDAVIT OF LOSS

I, JOHN NOAH PALOS AGUIRRE, of legal age, Filipino, single and with residence
address at 175 Iba, Este Purok 3, Calumpit, Bulacan, Philippines after having been sworn to in
accordance with law, hereby depose and states THAT:

1. I am a holder of Driver’s License duly issued by LAND TRANSPORTATION


OFFICE;

2. Sometime in March 2022, my wallet containing the said driver’s license was missing;

3. Despite diligent search and effort to locate the said wallet and the identification
cards contained therein, it could no longer be found, thus, I believe it is now lost
beyond recovery;

4. The said identification cards were not confiscated nor canceled by any authorities;

5. I am executing this affidavit to attest to the truth of the foregoing facts and for
purposes of my application for the re-issuance of new IDs in lieu of the lost one and
for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 10 th day of March, 2022
herein Guiguinto, Bulacan.

JOHN NOAH PALOS AGUIRRE

Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, a Notary Public for and in the Province
of Bulacan, today March 10, 2022 affiant, JOHN NOAH PALOS AGUIRRE, who subscribed
and sworn to the foregoing document and who avows under the PENALTY OF LAW to the
truth of the contents of the foregoing document.

I hereby certify that the affiant has been identified by the undersigned Notary Public
through the Competent Evidence of Identity, as follows:

Competent Evidence of Identity: TIN No. 394-501-870-000 which bears his picture and
signature.

Doc No. _____

Page No. _____;

Book No. ____;

Series of 2022.

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