Republic of the Philippines )

Province of Northern Samar )s.s.

Municipality of Catarman
)

AFFIDAVIT OF LOSS
I, BUENAVENTURA FABIO GALIT, Filipino, of legal age, married, and a
resident of Brgy. Cawayan, Catarman, Northern Samar, after having been
duly sworn to in accordance with law, hereby depose and state:
1.

That I
am the registered and lawful owner of a Drivers License duly
issued by the LTO, Catarman Branch;

2. That sometime in December 2015, I was looking for my wallet

where I inserted the above-mentioned Identification Card, but to my
surprise, said wallet could not be located anymore;
3.

That I
took pains to look for said belt bag and after exerting utmost effort
and due diligence in locating the same, said wallet containing my
aforementioned Identification Card placed therein is still nowhere to
be found;

4.

That, hence, I have come to the conclusion that the said belt bag
containing my aforementioned Identification Card is now
irretrievably LOST;

5. That I am requesting the LTO-Catarman to issue a new DRIVERS

LICENSE CARD in my name for and as a replacement for the
aforementioned lost Identification Card and I agree to indemnify and
hold the aforementioned Office free and harmless from any loss and
expenses that it may incur by reason of the issuance of a new
Identification Card;
6. That I am executing this affidavit merely to attest to the veracity of
the foregoing facts and for whatever legal intents and purposes this
may serve.
IN TRUTH WHEREOF, I hereunto set my hand this 20th day of October
2016 here at Catarman, Northern Samar, Philippines.
BUENA
VENTURA F. GALIT
Affiant

SUBSCRIBED AND SWORN to before me this 20th day of October

2016 here at Catarman, Northern Samar, Philippines, Affiant who is
personally known to me, who is the same person who personally signed
before me the foregoing affidavit of loss and acknowledged that he executed
the same.

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