REPUBLIC OF THE PHILIPPINES )
PROVINCE OF PANGASINAN )S.S.
MUNICIPALITY OF MANGALDAN )
AFFIDAVIT OF LOSS
I, CYRUS AQUINO, of legal age, Filipino citizen, married and a resident
of Brgy. Bateng, Mangaldan, Pangasinan after being sworn to in accordance
with law do herby depose and state that:
1. That I am a holder of a Professional Driver’s License No. A02-18-
002572 and OR CR issued by Land Transportation Office Dagupan City;
2. That I kept the said identification card and license inside my
black wallet;
3. That on August 23, 2020 at 3:30 in the afternoon, my black
wallet containing abovementioned card and licenses was lost and I suspect
that this wallet slipped out from my pocket unknowingly while on my way
home in Brgy. Bateng, Mangaldan, Pangasinan;
4. That I exerted exhaustive and extensive efforts to locate and
recover the wallet along with the card and license inside said wallet but no to
avail;
5. That I am executing this affidavit of loss to attest to the truth of
the foregoing and for whatever legal purpose it may serve.
IN WITNESS WHEREOF, I have hereunto set in my hands this August
25, 2020 in Mangaldan, Pangasinan.
CYRUS AQUINO
Affiant
SUBSCRIBED AND SWORN to before me this August 25, 2020 in
Mangaldan, Pangasinan.
ATTY. FERNANDO JUAN A. CABRERA
NOTARY PUBLIC
Doc. No. 96; UNTIL DECEMBER 31, 2021
Page No. 21; YDIA ST. BRGY. GUILIG, MANGALDAN, PANG.
Book No. 16; IBP No. 1058/12-4-19
Series of 2020. ROLL PTR No. 4232102/1-2-2020
NO. 62453/TIN 429-314-607-000
SNC-NP-15-2020
MCLE Comp. No. VI-0008445,5-9-18