I, ROZELLE SHAYNE R. RAMOS, of legal age, single, Filipino,
with residing at 431 Burgos Street Fortune Village 7, Barangay Parada, Valenzuela City, after having been duly sworn to in accordance with law, hereby depose and state that: 1. I am a bona fide holder of an LTO Non-Professional Driver’s License;
2. The afore-mentioned Driver’s License was lost or
misplaced while in my possession;
3. I exerted efforts to locate the said Driver’s License but to
no avail and are now considered lost and beyond recovery; and
4. This Affidavit of Loss is being executed to attest to the
truthfulness of the foregoing facts and circumstances.
This _____ day of June 2019, City of Manila.
ROZELLE SHAYNE R. RAMOS
Affiant
SUBSCRIBED AND SWORN TO before me, this
______________________ in the City of _________, by the affiant who presented to me her Passport with number _________________ issued on ________________________ at ________________________.