Republic of the Philippines)

)
x-----------------------------------x

AFFIDAVIT OF LOSS

I________________________, , of legal age, Filipino, and a resident of Brgy.

________________________________after having been duly sworn to in
accordance with law hereby depose and say:

That, I am the holder of a driver’s license (professional)

issued by the Land Transportation Office;

That, sometime in November 2016, I found out that the

said driver’s license was lost;

That, I exerted diligent efforts to locate the same but it

was to no avail;

That I am executing this affidavit in order to attest to the

truth of the foregoing in order to request the issuance of a
new driver’s license in lieu of the lost one and for whatever
legal intents and purposes it may serve.

IN TRUTH OF THE FOREGOING, I have hereunto set my hand this 16 th

day of June 2017, here at

Affiant

SUBSCRIBED AND SWORN to before me this 16 th day of June 2017 here

at