2019/4/24 Form No.

6--Affidavit of Loss Drivers License | Philippines Legal Form

Form No.6--Affidavit of Loss Drivers License

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Category: Philippines Legal Form
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(Affidavit of Loss Drivers License)
Republic of the Philippines)
Province of ____________________) S.S.
City/Municipality of _____________)
x---------x
AFFIDAVIT OF LOSS
I, _____________, Filipino, of legal age, (single / married / widow), and with residence at
_____________, Philippines, after being duly sworn to in accordance with law, hereby depose
and state:
That I am a duly-licensed driver in accordance with pertinent Land Transportation laws, rules
and regulations, and was issued a corresponding Driver's License with number _____________
which is valid until _____________;
That sometime last week, said Driver's License was misplaced and got lost.
That despite diligent search and efforts to locate my Driver's License, I could not find the
same such that I now believe that it is now lost beyond recovery;
That said Driver's License has not been confiscated by the LTO, Police or other Traffic
Enforcers for any traffic violation.
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 Driver's License, in lieu of the one that was
lost.
IN WITNESS WHEREOF, I have hereunto set my hand this _____________ at _____________,
Philippines.
AFFIANT
(JURAT)

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