AFFIDAVIT OF LOSS
I,
----------------,
of
legal
age,
Filipino,
single,
and
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 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 Professional Driver's License, in
lieu of the one that was lost;
IN WITNESS WHEREOF, I have hereunto set my hand this ------------------ in
----------------------------------------------------.
-------------------------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.