AFFIDAVIT OF LOSS

Know All Men By These Presents:

That I, ________________________, of legal age and a resident of

____________________________, after having been sworn to under the law
depose and state:

That I have been previously issued of ___________________ I.D.

sometime in the year __________.

That I habitually kept the said Identification cards in my wallet since

the day they were issued to me.

That last ______________________, I discovered that my said

Identification cards were missing and efforts to locate them proved futile.
Hence, they are already considered beyond recovery.

That I executed this affidavit to attest to the foregoing facts in order to

support my request for the re-issuance of said Identifcation cards to me and
for legal purpose.

In testimony whereof, I have executed and signed this instrument this

________________________ at ______________________.

Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, this

______________________ at ____________________.

Notary Public

Doc. No.
Page No.
Book No.
Series of ________