Republic of the Philippines )

Province of La Union )S.S.

Municipality of Naguilian )
x----------------- --x

AFFIDAVIT OF LOSS
I, LARRY F. FERRER, Filipino, of legal age, married and a resident of #391 Brgy.
Cobol, San Carlos City, Pangasinan, Philippines, after being duly sworn to in accordance with
law, hereby depose and state:

1. That I am a duly-licensed driver in accordance with pertinent Land Transportation

laws, rules and regulations, and was issued a corresponding Driver's License;

2. That I kept such driver’s license with me for safekeeping;

3. That on April 5, 2019 at around 9:00 o’clock in the morning while I was on board my
tricycle on my way to Barangay Mamat-ing, Naguilian, La Union, said Driver’s
License must have dropped from where I kept it and got lost;

4. That despite diligent search and efforts to locate my Driver's License, I could not find
the same such that I now believe that it is now lost beyond recovery;

5. That said Driver's License has not been confiscated by the LTO, Police or other
Traffic Enforcers for any traffic violation;

6. 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 the above-mentioned Driver’s
License in lieu of the one that was lost.

IN WITNESS WHEREOF, I have hereunto set my hand this 5 th day of April 2019 at
Naguilian, La Union, Philippines.

LARRY F. FERRER
Affiant

SUBSCRIBED AND SWORN to before me this 5th day of April 2019 at Naguilian, La
Union, Philippines.