AFFIDAVIT OF LOSS

I, __________________, of legal age, Filipino, married and a resident of Pasig City, 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 Transporation 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 located 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 (and renewal) of a new Non-Professional in lieu of
the one that was lost.

IN WITNESS WHEREOF, I have hereunto set my hand this ____________ 2018 in________ City,
Metro Manila, Philippines.

_________________________

Affiant

SUBSCRIBED AND SWORN TO before me this _______________________ 2018, in

________________ City, Philippines, Affiant exhibiting to me her competent evidence of identity
by way of (passport No. ) issued at ______________ on________________.

Doc No. __________;

Page No. __________;
Book No. __________;
Series of 2018.