AFFIDAVIT OF LOSS

I,

----------------,

of

legal

age,

Filipino,

single,

and

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 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 Professional Driver's License, in
lieu of the one that was lost;
IN WITNESS WHEREOF, I have hereunto set my hand this ------------------ in
----------------------------------------------------.

-------------------------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 2013.