REPUBLIC OF THE PHILIPPINES )

PROVINCE OF XYZ )
CITY/MUNICIPALITY OF ABC ) S.S.

AFFIDAVIT OF LOSS
(DRIVER’S LICENSE)

I, HYUN BIN GO, of legal age, single, Filipino and presently residing at
________________________________, after having been duly sworn to in accordance
with law, depose and state THAT:

1. I am a Grab Food Express Driver;

2. I was on my way to the nearest photocopying services to photocopy the

latest Memorandum pertinent to guidelines for the management of the coronavirus
disease 2019 issued by the Office of the President;

3. On my way to said photocopying services, I was stopped by at the

checkpoint in _________________________________;

4. As the complete lockdown is being implemented in

___________________ and only essential services and/or things can be availed of by
residents herein, I plead to the officers manning the checkpoint to let me proceed to the
photocopying services as the document I need to photocopy is very important in my
job/work;

5. To let me passed through the checkpoint, I left my Driver’s License to the

officer manning the checkpoint. After I accomplished the thing I need to do, I
immediately proceed on my way home. However, upon reaching the checkpoint again
to retrieve my driver’s license, said driver’s license was nowhere to be found;

6. The officer manning the checkpoint tried to look for it and search the area,
but said effort found to be futile;

7. 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 new driver’s license in lieu of
the lost one;

8. And as there are no available Notary Public in the place and considering
further that an Enhanced Community Quarantine is being implemented in the entire
Luzon, I am subscribing this Affidavit before the Mayor of
________________________.

IN WITNESS WHEREOF, I have hereunto set my hand this 18 th day of March

2020 at ________________________, Philippines.
 HYUN BIN GO
Affiant

SUBSCRIBED AND SWORN TO before me this ___ day of March 2020 in

________________, Philippines, affiant exhibiting to me his Government Issued ID
_________________________________ as competent evidence of identity.

ADMINISTERING OFFICER