REPUBLIC OF THE PHILIPPINES)CITY OF MANILA             ) S.S.  

AFFIDAVIT OF LOSS

I, ______(Name)______, of legal age, Filipino, single, and a resident of ___________________(Address)_____________________, 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) Professional Driver's License with number _(Card Number)_ which is valid until _(Date of Validity)_;

2. Sometime on _(Date of loss)_, 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 _(Date of signing)_ in the City of Manila, Metro Manila, Philippines.

NameAffiant

(Any Government issued ID and ID no.)

 SUBCRIBED AND SWORN TO before me this ___________________ in _________________, Philippines, affiant exhibiting to me his/her competent evidence of identity by way of (Any Government Issued ID) issued at (Place of Issuance)

Doc. No. _____;Page No. _____;Book No. _____;Series of 2015.