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Affidavit of Loss (Template)

Simon Aqui N. Diaz, a resident of Mandaluyong City, declares in an affidavit that he has lost his Driver’s License No. F07-11-000717, which expired on March 28, 2022. He searched for the license on June 23, 2021, but was unable to locate it despite diligent efforts. The affidavit is executed for legal purposes to attest to the loss of the driver's license.

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Simon Diaz
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48 views1 page

Affidavit of Loss (Template)

Simon Aqui N. Diaz, a resident of Mandaluyong City, declares in an affidavit that he has lost his Driver’s License No. F07-11-000717, which expired on March 28, 2022. He searched for the license on June 23, 2021, but was unable to locate it despite diligent efforts. The affidavit is executed for legal purposes to attest to the loss of the driver's license.

Uploaded by

Simon Diaz
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd

REPUBLIC OF THE PHILIPPINES )

PASIG CITY ) SS.

AFFIDAVIT OF LOSS

I, SIMON AQUI N. DIAZ, of legal age, Filipino and residing at South 1710 Flair
Towers, Reliance cor. Pines St., Mandaluyong City, after being first duly sworn
according to law, hereby depose and state:

1. I am a holder of a Driver’s License No. F07-11-000717 expiring on 28


March 2022.

2. On 23 June 2021, I searched for my above-mentioned driver’s license


among my personal belongings. However, I could no longer find it.

3. Despite my diligent efforts to find my said driver’s license, I failed to locate


it. Thus, it is now deemed lost and beyond retrieval.

4. I am executing this affidavit to attest to the truth of the foregoing and for
whatever legal purpose it may serve.

AFFIANT FURTHER SAYETH NAUGHT.

SIMON AQUI N. DIAZ

Affiant

SUBSCRIBED AND SWORN to before me this 23rd of June 2021, at Pasig City,
Philippines, affiant exhibiting to me his PRC ID No. 0163887.

Doc. No. _________;


Page No. _________;
Book No._________;
Series of 2021.

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