REPUBLIC OF THE PHILIPPINES
CITY OF MAKATI )
x----------------------------x
AFFIDAVIT OF LOSS
I, ___________________, of legal age, Filipino, (single/married/widow) and a resident of _______________________________, 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 _____________ which is valid until _____________;
2. Sometime on ____________, 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 ___________________ in Makati City, Metro Manila, Philippines .
____________________
Affiant
SSS ID No. _____________
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SUBCRIBED AND SWORN TO before me this ___________________ in _________________, Philippines, affiant exhibiting to me his/her competent evidence of identity by way of __________________ issued at ______________ on __________________.
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2013.