Affidavit of Loss OR Drivers License

REPUBLIC OF THE PHILIPPINES) CITY OF MANDALUYONG) S.S. x----------------------------x

AFFIDAVIT OF LOSS  I, Marc L a u r e n ze C. Ce!", #$ e e%a %a a% a%e& e& F!! F! !'! '!n# n#&& ("!n%e*arr!e+,!+#,) an+ a re"!+en #$ -/ D#n 0!cene S.& 0!a D## D# #re re" " Su Su1+. 1+.&& An% An%e ee" e" C! C!2 2&& a$ a$e err 3a 3a4! 4!n% n% 1e 1een en +u +u2 2 ", ",#r #rn n # !n acc#r+ance ,!3 a,& +e'#"e an + "ae THAT5

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SUCRIED AND SWORN TO 1e$#re *e 3!" ___________________ !n      && P3! P3!!'' !''!ne !ne"& "& a$$!an ex3!1!!n% # *e 3!"3er c#*'een e4!+ence #$ !+en!2 12 ,a2 #$  !""ue+ a             #n .

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