Republic of the Philippines

Province of Cagayan
City of Tuguegarao

AFFIDAVIT OF LOSS

I, DELVIN JOHN C. FERRER, of legal age, Filipino, and resident of 171 Lecaros
St., Ugac Sur, Tuguegarao City, Cagayan, after being duly sworn according to
law, hereby depose and state that:

1. I am the holder / owner of Driver’s License with License number B04-

08-004148 issued by the Land Transportation Office (LTO);

2. Sometime in January 2023, I was about to use the said Driver’s License
for identification purposes but the same could not be found in my wallet;

3. Despite diligent efforts exerted, I could no longer locate, find or recover the
said Driver’s License and to the best of my knowledge, the same is truly
lost;

4. The said Driver’s License has not been confiscated by any officer of the
law or the issuing office or agency due to the violation of any law, statute,
order, rule or regulation;

5. In the event that the lost driver’s License should hereafter be found or
located, I undertake to forward or surrender the same to LTO REGION 02
for appropriate disposal.

6. I am executing this Affidavit to attest to the truth of the foregoing

statements and to request the issuance of a new Driver’s License in lieu of
the one which was lost.

AFFIANT FURTHER SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto set my hand this

_________________ at Tuguegarao City.

DELVIN JOHN C. FERRER

SUBSCRIBED AND SWORN to before me this __________________, affiant

exhibited to me his/her Competent Evidence of Identity by way of
______________________________ issued at Tuguegarao City.

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