REPUBLIC OF THE PHILIPPINES )

City of Toledo …………………………………) S.S.

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

AFFIDAVIT OF LOSS
I, __________________, of legal age, Filipino, and a resident of Langub, Asturias, Cebu,
after having been duly sworn to in accordance with law, hereby depose and state:
That I am a holder of a Driver’s License validly issued by the Land Transportation’s
Office;
That unfortunately, due to inadvertence, the said Driver’s License could no longer be
found;
That despite diligent search and efforts, said document could no longer be located such
that I believe it is now lost beyond recovery;
As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing
statements for whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 17 February 2015 at

Toledo City, Philippines.

___________________________
Affiant

SUBSCRIBED AND SWORN to before me, this 17 February 2015, by the Affiant who is
known to me through his competent evidence of identity above-described.

Doc. No. ______;

Page No. ______;
Book No.______;
Series of 2015.