REPUBLIC OF THE PHILIPPINES)
CITY OF BAGUIO) SS.
AFFIDAVIT OF LOSS
I, PABLING ATITIW, Filipino, of legal age, single and a resident of
Cares, Pugo, La Union, hereby declare and state that:
1. I am the owner of a Kawasaki Ninja H2 motorcycle, which I use
for my livelihood as an itlog pugo vendor;
2. That while on my way to BGC to sell my itlog pugo, I inadvertently
lost my wallet from my person. The wallet contained my non-
professional driver's license;
3. I have made a diligent search for my lost wallet but was unable
to recover it.;
4. I also went before the Land Registration Office (LTO) to oath and
affirm that I, neither transfer, surrender, handover nor revoke my non-
professional driver’s license;
5. I am not also aware of anyone who may have found or taken my
Wallet; and
6. The contents of my wallet are of great importance to me as it is
my livelihood as a vendor.
IN WITNESS WHEREOF, I have hereunto affixed my signature
this 27th day of September at Baguio City Philippines.
(SDG)
PABLING ATITIW
Affiant
SUBSCRIBED AND SWORN TO before me in Baguio City,
Philippines, this 27th day of September 2024 by the above-named
affiant, who has satisfactorily proven to me his identity through his
PhilHealth ID with an I.D number 00-123456789-1, issued on 7th of
August 2024, to be the same person who presented and personally
signed before me this AFFIDAVIT OF LOSS and attested that the
contents thereof are true and correct; and that he voluntarily executed
the same.
(SDG)
ATTY. REY YNGSON, JR.
NOTARY PUBLIC
Commission No. 111111 Baguio City, Philippines 12/12/27
Roll No. 222222
IBP No. 333333, 12/12/25
PTR No. 4444444, 12/12/27
MCLE Compliance No. 555555, 12/12/27
General Luna Road, Baguio City; 2227604@slu.edu.ph
