Republic of the Philippines

City of Angeles

)
)S.S.

AFFIDAVIT OF LOSS
I, AAA, of legal age, Filipino, married and with postal address at
______, after having been sworn to in accordance with law, do hereby
deposes and states:
1. That I was issued a Drivers License Card by the Land
Transportation Office with no. ________.
2. That I keep the same in my wallet for safekeeping.
3. That this morning, I tried to retrieve the said Drivers License
Card, however, it was missing.
4. That I exerted efforts to locate the above-mentioned Drivers
License Card but all proved futile and beyond recovery, thus, I
consider the same as lost;
And that I am executing this affidavit in order to attest to the
truth of the foregoing.
Affiant sayeth naught.
AAAA
Affiant