REPUBLIC OF THE PHILIPPINES)

CITY OF MANILA
) S.S.

AFFIDAVIT OF LOSS
I, ______(Name)______, of legal age, Filipino, single, and a
resident
of
___________________(Address)_____________________,
after having been duly sworn to in accordance with law, 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
_(Card Number)_ which is valid until _(Date of Validity)_;
2. Sometime on _(Date of loss)_, 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;
IN WITNESS WHEREOF, I have hereunto set my hand this _(Date
of signing)_ in the City of Manila, Metro Manila, Philippines.

Name
Affiant
(Any Government issued ID and
ID no.)
SUBCRIBED AND SWORN TO before me this ___________________
in _________________, Philippines, affiant exhibiting to me his/her
competent evidence of identity by way of (Any Government Issued ID)
issued at (Place of Issuance)
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2015.