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Republic of the Philippines)

City of Makati) S.S


x--------------x
AFFIDAVIT
I, MICHELLE C. CHOA of legal age, Filipino, single, and a
resident of Unit 614 Greenbelt Residences, Arnaiz Avenue, Makati
City, after having been sworn in accordance with law, do hereby
depose
and
state
that:

1. I am a duly-licensed driver in accordance with pertinent Land


Transportation laws, rules and regulations, and was issued a
corresponding (Non) Professional Driver's License with number
DL3510JK8 which is valid until May 8, 2015.
2. On November 30, 2014 said driver's license was misplaced
and got lost;
3. Efforts were exerted to locate said driver's license, but in spite
of diligent search, it could not be found and the same is now
beyond recovery;
4. Said Driver's License has not been confiscated by the LTO,
Police or other Traffic Enforcers for any traffic violation;
5. As such, I am executing this Affidavit of Loss to attest to the
truth of the foregoing and to support my application for the
issuance of a new (Non) Professional Driver's License, in lieu
of the one that was lost;
FURTHER AFFIANT SAYETH NAUGHT.

MICHELLE C. CHOA
Affiant
SUBSCRIBED AND SWORN TO before me this 15 th day of
December 2014, affiant exhibiting to me her SSS ID with card no.

JKL000686, issued by the Social Security System in Makati on 1


March 2014.

Atty.
PROTASIO

JOSINE

MA.

V.

Senior Partner
ORTIZ MANALANG VER AND
UYTIOCO
Commission (Serial) No. 12345
San Antonio City
Roll of Attorneys No. 42345
IBP No. 23456/1-06-14/Makati
PTR No. H-456789/1-06-14/Makati

Doc. No. 35
Page No. 4

Book No. 110


Series of 2014

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