REPUBLIC OF THE PHILIPPINES )

PROVINCE OF ORIENTAL MINDORO )S.S.

MUNICIPALITY OF ROXAS )
X----------------------------------------------X

AFFIDAVIT OF LOSS
I, JOHN PAUL O. MANSILLA, Filipino, of legal age, single and with
residence and postal address at San Mariano, Roxas, Oriental Mindoro, after
having been duly sworn in accordance with law hereby depose and state that:

1. I was a holder of Professional Driver’s License issued by the Land

Transportation Office, Calapan City, Occidental Mindoro;
2. On November 25, 2018, our house got burned. Unfortunately, among
the items/possessions which were not saved was my Professional
Driver’s License;
3. I avow under the penalty of law that the aforesaid Professional
Driver’s License was not confiscated by any authorities for violations
of traffic rules and regulations;
4. I am executing this affidavit to attest to the truth of the foregoing and to
request the good office of the Land Transportation Office to issue a new
Driver’s License in lieu of the lost one.

IN WITNESS WHEREOF, I have hereunto set my hand this 10th day of

December 2018 at Roxas, Oriental Mindoro.

JOHN PAUL O. MANSILLA

Affiant
VIN: 5212-0079A-J1393JIM10000-8
Issued by COMELEC, Roxas, Or. Mindoro

SUBSCRIBED AND SWORN to before me, 10th day of December 2018 at

Roxas, Oriental Mindoro.

Docket No.: 48;

Page No.: 10; Public Attorney II
Book No.: XII; Pursuant to R. A. 9406
Series of 2018.
REPUBLIC OF THE PHILIPPINES )
PROVINCE OF ORIENTAL MINDORO )S.S.
MUNICIPALITY OF ROXAS )
X----------------------------------------------X

AFFIDAVIT OF LOSS
I, BONIFACIO M. ACLAN, Filipino, of legal age, married and with
residence and postal address at San Aquilino, Roxas, Oriental Mindoro, after
having been duly sworn to in accordance with law hereby depose and state:
1. That I am the holder/custodian of the following:
a) Prof. Driver’s License
b) SSS ID

2. That the above-stated cards were in my possession from the time of

its issuance but sometime on July 11, 2018 while I was at San
Aquilino, Roxas, Oriental Mindoro the above stated Cards were lost;
3. That notwithstanding diligent effort to find my CARDS and the same
cannot be found or restored to this date;
4. That I executed this statement for the purpose of respectfully asking
the good officials of the said agencies to invalidate my CARDS and
reject any transaction using the same;
5. That if recovered or located, I shall return the lost/stolen missing
Identification Cards immediately to the good offices for cancellation;

6. That I further attest that I have not pawned such Identification Cards
or used such as collateral in any loan in any bank or lending
institution, and that if it is found that I have done so, I know and
understand that I will be held liable for perjury.
7. That I further executed this affidavit to attest to the truth of the
foregoing statement.

IN WITNESS WHEREOF, I have hereunto set my hand this 20th day of

July, 2018 at Roxas, Oriental Mindoro.

BONIFACIO M. ACLAN
Affiant
SUBSCRIBED AND SWORN to before me, this 20th day of July, 2018 in
Roxas, Oriental Mindoro, with affiant exhibiting his Voter Certification with
No. ______________________________ issued at Roxas, Oriental Mindoro.

Docket No.: 291; ATTY.

Page No.: 58; Public Attorney III
Book No.: X; Pursuant to R. A. 9406
Series of 2018.