REPUBLIC OF THE PHILIPPINES)

Baguio City……………………) S.S.

A F F I D A V I T OF LOSS
[ Re: PROFESSIONAL DRIVER’S LICENSE]

I, , of legal age, Filipino Citizen, married and with residence address at #73C Tacay Road
Quezon Hill. , after having been duly sworn to in accordance with law, do hereby depose and
state that:

I was issued a PROFESSIONAL DRIVER’S LICENSE by the Land Transportation

Office (LTO);

The said driver’s License was safely kept inside my wallet. However on July 31, 2019,
the wallet containing the driver’s license was loss/missing somewhere along Session Road
Baguio City;
I exerted diligent efforts to locate my wallet containing my DRIVER’S LICENSE and
other CARDS` by looking into places where it might have been thrown away, or misplaced, and
by inquiring as to whoever might have taken it, but, unfortunately, all my efforts were in vain. I
strongly believe that my said DRIVER’S LICENSE was forever lost and beyond recovery;

The same was not given to any entity for the satisfaction of any debt nor confiscated by
any law enforcement authority for violation of any law. Neither is the same cancelled, revoked or
withdrawn for violation of DOTr-CAR, LTO or LTFRB laws, rules and regulations;

If the LTO – BAGUIO CITY Licensing Center, after inquiry, will find me responsible for
the unauthorized use of the herein reported loss of my DRIVER’S LICENSE I am executing this
affidavit in good faith to attest to the truthfulness and veracity of the foregoing facts and for all
legal intents and purposes. I do hereby signify my conformity to meted administrative fines and
penalties due and imposed thereon, with waiver and desistance on my part for any legal claim or
action by reason of the aforementioned punitive measures taken against me; and

IN WITNESS WHEREOF, I have hereunto set my hand this 14th day of August 2019
at Baguio City, Philippines.

Affiant

SUBSCRIBED AND SWORN TO BEFORE ME this 14th day of August 2019 at

Baguio City, Philippines.