REPUBLIC OF THE PHILIPPINES )PROVINCE OF CAGAYAN ) S.SCITY OF TUGUEGARAO )

AFFIDAVIT OF LOSS

I, WENIFREDA A. DOMINGO, of legal age, married, Filipino citizen, and a resident of Aurora, Isabela after having been duly sworn to in accordance with law, do hereby depose and state under oath that –

1. I am a holder of a vehicular plate issued by the Land Transportation Office, Tuguegarao City, Cagayan;

2. At around 1 o’clock in the afternoon last May 1, 2015; I discovered that my vehicular plate bearing number XMW667 was then missing. I went back to the places where I had been for I might have just dropped it without me noticing it immediately hoping that I could still find the same and that some good person might have seen the same;

3. However, despite diligent search and effort to locate the said driver’s license, the same could no longer be found. Hence, it is deemed lost and beyond recovery;

4. I am executing this affidavit to attest the veracity and truthfulness of the foregoing facts that my Driver’s License was indeed lost and for whatever legal intents and purposes it may serve.

Further affiant sayeth naught.

IN WITNESS WHEREOF, I have hereunto set my hand this 4th

day of May, 2015 at Tuguegarao City, Cagayan.

WENIFREDA A. DOMINGO Affiant

SUBSCRIBED AND SWORN to before me this this this 4th day of May, 2015 at Tuguegarao City, Cagayan.

Doc. No. ________;Page No. ________;Book No. ________;Series of 2015.