AFFIDAVIT OF LOSS

I, _______________________, of legal age, Filipino, single 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 a corresponding _____________________________;
2. Sometime in ______________, 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, I have hereunto set my hand this __ day of December 2018 in ______
City, Metro Manila, Philippines.

____________________________
Affiant

SUBCRIBED AND SWORN TO before me this __ day of _________ 2018 in ______ City, Philippines,
affiant exhibiting to me his competent evidence of identity by way of his _______________ issued at
_________ City.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2018.