REPUBLIC OF THE PHILIPPINES)

CITY OF MAKATI) S.S.

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

AFFIDAVIT OF LOSS

I, ___________________, of legal age, Filipino, married, and a resident of

_______________________________, 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 2023,