You are on page 1of 2


I, Cedric Jerome M. Cruz, of legal age, Filipino, Single and a resident of Baliuag Bulacan
, 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 (Non) Professional Driver's
License with number 0018323 which is valid until June 25, 2017

2. Sometime on April 25 2016, 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 2nd day of March
2016 in Makati City, Metro Manila, Philippines.

Cedric Jerome M. Cruz

SSS ID No. 1434

SUBCRIBED AND SWORN TO before me this 2nd day of March 2016 in Makati
, Philippines, affiant exhibiting to me his valid proof of identification.
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2013.