Republic of the Philippines )

Province of Bulacan ) S.S

City of Malolos )
AFFIDAVIT OF LOSS
I, JOHN MARK T. ARCILLA, Filipino, of legal age, resident
of Doña Crispina Homes, Agnaya, Plaridel, Bulacan, after
having been duly sworn to in accordance with law, hereby
depose and state:
1. I am a holder of non-professional driver’s license no.
N01-08-018749 issued by the Land Transportation
Office (LTO), East Ave., Quezon City;

2. Sometime in June 2010, while riding a public utility

vehicle (jeep), I accidentally lost/dropped my wallet
containing my aforesaid driver’s license;

3. I exerted all diligent efforts to locate the said wallet with

my driver’s license but it could no longer be found;

4. I am executing this Affidavit to narrate the

circumstances relative to the loss of aforesaid driver’s
license and to request the LTO to renew the same
license or issue a new one in my behalf.
AFFIANT SAYETH NONE.
Malolos City, Bulacan, January 21, 2019.

JOHN MARK T. ARCILLA

Affiant

SUBSCRIBED AND SWORN TO before me this 21 st day of

June, 2019, affiant exhibiting to me his Postal ID No. PRN
D39160622484 P, valid until December 13, 2019.