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

corresponding

(Non)

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 (Non) Professional Driver's License, in
lieu of the one that was lost;
IN

WITNESS

WHEREOF,

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

on __________________.
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2013.

__________________

issued

at

______________