REPUBLIC OF THE PHILIPPINES)

ANGELES CITY

)S.S.

AFFIDAVIT OF LOSS
I, ____________, Filipino, of legal age, married and currently residing at
___________________________, after being duly sworn to in accordance with law,
hereby depose and say, thus:
1. That I am a lawful holder of a Philippine Drivers License issued by
the Land Transportation Office;
2. That the said Drivers License was kept inside my wallet;
3. That on July 22, 2016, I noticed that my wallet where I kept my
Drivers License went missing I cannot find the same;
4. That I exerted all best effort to search for the said wallet and
Drivers License but to no avail and the same is now lost beyond recovery;
5. As such, I am executing this Affidavit of Loss to attest to the truth of
the foregoing and to support my request for the issuance of a new Drivers
License in lieu of the one that was lost.
IN WITNESS WHEREOF, I have hereunto set my hand this 23 rd day of
July, 2016 at Angeles City, Philippines.

_____________________________
Affiant
SUBSCRIBED AND SWORN TO before me this 23rd day of July, 2016
at Angeles City, Philippines. Affiant personally known to me