REPUBLIC OF THE 

PHILIPPINES)
CITY OF Baguio          ) S.S.
x----------------------------x
  

AFFIDAVIT OF LOSS

 I, Arnel Danis, of legal age, Filipino, married and a resident of Tomay, 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) Professional Driver's License
with number _____________ which is valid until _____________;

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

3. Efforts were exerted to locate said driver'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 this Affidavit 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 Makati City, Metro Manila, Philippines.

____________________
Affiant
SSS 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 2013.