REPUBLIC OF THE PHILIPPINES)

CALOOCAN CITY ) S.S.

AFFIDAVIT OF LOSS

I, ____________, of legal age, Filipino and with residence and postal address at
______________, after having duly sworn to in accordance with law, hereby depose and
state:

1. That I was in possession of a Non- Professional Driver’s License duly

issued by the LTO;
2. That the said Non-Professional Driver’s License was lost/missing;
3. That I cannot recall whether the said Non-Professional Drivers License
was misplaced at home or I accidentally dropped outside our premises or
places that I had been;
4. That I diligently searched for the said missing Non-Professional Drivers
License in our house and made inquiries with my family who might have
seen the said missing Non-Professional Drivers License but all efforts
proved futile as I can no longer locate the said Non-Professional Drivers
License and the same is now beyond recovery;
5. That I am executing this affidavit to attest to the truth of the foregoing
facts and for whatever it may serve best
AFFIANT SAYETH NAUGHT.

__________________
Affiant

SUBSCRIBED AND SWORN to before me this 11 th day of June 2013 at

Caloocan City, Metro Manila. Affiant exhibited to me his ID No. ______________.

Doc. No. ___________

Page No. ___________
Book No. __________
Series of 2013