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)
ProfessionalDriver'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. _____________

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.