REPUBLIC OF THE 

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

AFFIDAVIT OF LOSS 

I, Edgardo C. Iringan, of legal age, Filipino, single and a resident of #6 Amado

Cmpd. Burgos Rod, Rizal. Philippines, after having been duly sworn to in
accordance with law, depose and state:

1. That I am legitimate holder of DRIVER’S LICENSE issued by LTO Quezon City.

2. That sometime on January 27, 2022, the said DRIVER’S LICENSE was lost
due to misplacement.

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. That in view thereof, I now desire and hereby request to issue another

DRIVER’S LICENSE in lieu of the lost one;

5. That I am executing this affidavit to attest to the foregoing facts and for any
legal purpose it may serve.

         IN WITNESS WHEREOF, I have hereunto set my hand this _______ of

________ in Quezon City, Metro Manila, Philippines.
          

Edgardo C. Iringan
Affiant

    SUBCRIBED AND SWORN TO before me this ______________ in Quezon

City, Metro Manila, Philippines, affiant exhibiting to me his valid proof of
identification.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2022.