REPUBLIC OF THE PHILIPPINES)

Quezon City, Metro Manila )S.S.

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AFFIDAVIT OF LOSS

I, Danilo Blanco, of legal age, married, Filipino, and a resident of

#696 Kasarapan St., Masbate City, Masbate, after having been duly
sworn in accordance with law, hereby depose and say that:

1. I am holder of Non-professional Driver’s License issued

sometime in 2010 by Land Transportation Office, Quezon City;

2. The said Driver’s License was usually put in my wallet;

3. Sometime in November 2012, while I was going from the office, I

did not notice that my wallet which contained my Driver’s
License slipped off and fell from my pocket;

4. I have exerted all my efforts to recover said Driver’s License but

to no avail, the same is now lost and beyond recovery;

5. My Driver's License has not been confiscated by the LTO, Police

or other Traffic Enforcers for any traffic violation;

6. I am executing this affidavit to attest the veracity of the

foregoing facts and to request the Land Transportation Office to
issue me a new driver’s license in lieu of the lost one.

IN WITNESS WHEREOF, I have hereunto set my hand this 7 th

day of August 2017 in Quezon City, Metro Manila.

DANILO BLANCO
Affiant
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______________
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SUBSCRIBED AND SWORN TO before me this 7TH day of August

2017 in Quezon City, Metro Manila.

Notary Public

Doc. No. ____;

Page No. ____;
Book No. ____;
Series of 2017.