REPUBLIC OF THE PHILIPPINES)

PROVINCE OF xxx ) SS.

MUNICIPALITY OF xxx)
X-------------------------------------------X

AFFIDAVIT OF LOSS

I, xxx, of legal age, Filipino, single, and a resident of Brgy. xxx, xxx, La Union, after
having been duly sworn to on oath in accordance with law, hereby depose and state that:

1. On May 30, 2021, I was preparing my National ID requirements when I realized that I
couldn’t find my Professional Driver’s License;

2. The last time I saw my Professional Driver’s License was sometime last week when I
presented the same to a police officer;

3. As far as I remember, I placed my Professional Driver’s License inside my sling bag after
the police officer checked the same;

4. Unfortunately, when I looked for it again on May 30, 2021, it was no longer inside said
bag;

5. That I exerted earnest efforts to recover/retrieve the same but to no avail;

6. That my Professional Driver’s License is now beyond recovery, hence, considered lost.

That I am executing this Affidavit to attest to the truthfulness of the foregoing and for all
legal intents and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 1st day of June 2021, in the
Municipality of xxx, xxx, Philippines.

xxx.
Affiant
Voter’s Identification No.: xxxx

SUBSCRIBED AND SWORN TO before me this 1st day of June 2021, in the
Municipality of xxx, xxx, Philippines. Affiant personally appeared before me.

ATTY. xxx