AFFIDAVIT OF LOSS

I, ANGELO C. JACLA, 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 Non - Professional Driver's License with number
D16-05-301715 which is valid until January 13, 2008;

2. Sometime in June 2019, 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 14th day of June 2019 in
Masinloc, Zambales, Philippines.

ANGELO C. JACLA
Affiant

SUBCRIBED AND SWORN TO before me this 14th day of June 2019 in Masinloc
Zambales, Philippines, affiant exhibiting to me his competent evidence of identity by way of
Voter’s I.D VIN 7403-0660B-A1387LFB10000 issued at Pasig City.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2014.