REPUBLIC OF THE PHILIPPINES }

CAGAYAN DE ORO CITY } S.S.

AFFIDAVIT OF LOSS

I, __________________________, of legal age, Filipino, single, and a resident of

___________________, after having been duly sworn to an oath in accordance with law,
hereby depose and state that:

1. I am a duly licensed driver in accordance with pertinent Transportation

laws, rules, and regulations, and was issued a corresponding Non-Professional
Driver's License;

2. Sometime in 2015, I lost my driver’s license while I was in Manila;

3. I was not able to acquire immediately a replacement driver’s license

since I went abroad;

4. Efforts were exerted to locate the said driver’s license, but in spite of
diligent search, it could not be found and the same is now beyond recovery;

5. The said driver's license has not been confiscated by any law
enforcement agency;

6. Moreover, there has been no pending or unresolved case for

apprehension, alarm, suspension or revocation involving the said driver’s license;

7. 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

the City of Cagayan de Oro, Philippines.

____________________________________
Affiant

SUBSCRIBED AND SWORN to before me this _______________________ in

____________________, affiant exhibiting to me his Passport ID with No. __________________
issued by the Department of Foreign Affairs.

Doc No. _____

Page No. ______
Book No. ______
Series of 2020.