Republic of the Philippines)

Province of Bulacan) S.S.

City of Malolos)
x---------x

AFFIDAVIT OF LOSS

I, Juan Dela Cruz, Filipino, of legal age, single, and with residence at 123

Guinhawa, Malolos Bulacan, Philippines, after being duly sworn to in
accordance with law, hereby depose and state:
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 with number C10-2034-1234 which is valid
until October 1, 2024;
That sometime last week, said Driver's License was lost due to my wallet
being stolen.

That despite diligent search and efforts to locate my Driver's License, I could

not find the same such that I now believe that it is now lost beyond
recovery;
That said Driver's License has not been confiscated by the LTO, Police or
other Traffic Enforcers for any traffic violation.

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 July 29, 2020 at
City of Malolos, Bulacan, Philippines.

Juan C. Dela Cruz

Affiant

SUBSCRIBED AND SWORN to before me, this 29th day of July 2020, by Juan
C. Dela Cruz, who exhibited to me his Social Security System ID No. 12-
1234567-90 issued at Malolos, Bulacan, Philippines on January 0, 2020.

Atty. Khristienne Rian C. Bernabe

Notary Public
 Until December 31, 2021

PTR No. 123456788/ 1-3-2021

IBP No. 23456789/ 1-3-2021

MCLE No. III 12345678

Roll No. 51015

Doc. No. ______;

Page No. ______;

Book No. ______;

Series of ______;