REPUBLIC OF THE PHILIPPINES)

CITY OF MAKATI

) S.S.

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

AFFIDAVIT OF LOSS
I,

___________________, of

legal

age,

Filipino,

(single/married/widow)

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 (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 2013.