REPUBLIC OF THE 

PHILIPPINES)
__________________________ ) SS.

AFFIDAVIT OF LOSS

I, DHENZELL V. BULAWAN, of legal age, Filipino Citizen and residing/with address at

Unit 7 Mangosteen St., Pagrai Hills Mayamot Antipolo City, after having been duly sworn
according to law , depose and state;

1.     That I am a holder of a Non-Professional Driver License with No. D35-21-001304

issued by the Land Transportation Office,

2.    That I lost the said Non-Professional Driver License on June 5, 2023

3. That I exerted all efforts to locate the same but could not find it and considered it
lost for all legal purpose;

4. That the said Non-Professional driver license was not confiscated by any officer of
the law by reason of any violation of any law ordinance or presidential decree, rules or
regulation of the said Office;

5.     That I am executing this Affidavit to inform the LTO that the said Non-Professional
Driver License was lost and never recovered;

6. That I attest to the truth of the foregoing facts.

FURTHER AFFIANT SAYETH NONE.

IN WITNESS WHEREOF, I hereunto affix my signature this _______________ at

__________________Philippines.

DHENZELL V. BULAWAN
Affiant

SUBSCRIBED AND SWORN to before me this _______________ at

____________Philippines. Affiant exhibiting to me his UMID CRN-0113-0646990-4 issued at
_________________ on ___________________________.

Doc No. __;

Page No. __;
Book No. __;
Series of 2023.