REPUBLIC 

OF THE PHILIPPINES)

CITY OF PASIG        ) S.S.

x-----------------------------------x

  

AFFIDAVIT OF LOSS

 I, MARLON CHINO N. MORALES,  of legal age, Filipino, single and a resident of
Tower 6 18A Forbeswood Heights BGC Taguig City, Philippines, after having been
duly sworn to in accordance with law, depose and state THAT:

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

Transportation laws, rules and regulations, and was issued a corresponding (Non)
ProfessionalDriver's License with number E05-99-018101 which is valid until April
9, 2017

2. Sometime on ____________, said driver's license was misplaced and got

lost;

3. Efforts were exerted to locate saiddriver's license, but in spite of diligent search, it
could not be found and the same is now beyond recovery;

4. Said Driver's License has not been confiscated by the LTO, Police or other

Traffic Enforcers for any traffic violation;

5. As such, I am executing thisAffidavit of Loss to attest to the truth of the foregoing

and to support my application for the issuance of a new (Non) Professional Driver's
License, in lieu of the one that was lost;

IN WITNESS WHEREOF, I have hereunto set my hand

this ___________________ in Mandaluyong City, Metro Manila, Philippines.
 MARY GRACE R. LAO

Affiant

ID No. _____________

 SUBCRIBED AND SWORN TO before me this ___________________ in

_________________, Philippines, affiant exhibiting to me his/her competent
evidence of identity by way of __________________ issued at ______________
on __________________.

Doc. No. _____;

Page No. _____;

Book No. _____;

Series of 2017.