Republic of the Philippines)

City of Puerto Princesa )S.S

AFFIDAVIT OF LOSS

I, ______________________, of legal age, Filipino, and a resident of New Buncag,

Bgy. Mandaragat, Puerto Princesa City, Palawan, after having been duly sworn to in
accordance with law, depose and state THAT:

1. That I am a duly-licensed driver in accordance with pertinent Land Transportation

laws, rules and regulations, and was issued a corresponding Driver's License;

2. That sometime on OCTOBER 2022, said driver's license was misplaced and got lost;

3. That 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. That the 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 Driver's License, in lieu of the one
that was lost;

IN WITNESS WHEREOF, I have hereunto set my hand this 26TH day of

September 2023 in Puerto Princesa City, Palawan, Philippines.

_______________________________
Affiant
PAG-IBIG ID No. 1210-8578-8775

SUBCRIBED AND SWORN TO before me this 26TH day of September

2023 in Puerto Princesa City, Palawan, Philippines, affiant exhibiting to me his
valid proof of identification.

Doc. No. _____;

Page No. _____;
Book No. 001;
Series of 2023.