REPUBLIC OF THE 

PHILIPPINES)
QUEZON CITY ) S.S.

AFFIDAVIT OF LOSS
I, ____________________________,of legal age, Filipino and with
residence address located at
________________________________________________,after having been
duly sworn to in accordance of the law depose and state that:

1. That I am the holder and owner of DRIVER’S LICENSE CARD (Non-

Professional) issued by the LAND TRANSPORTATION OFFICE (LTO);

2. That sometime on___________________ around ______________,

while I was travelling along Makati City, I notice that my Driver’s
License I.D. Card was missing and I assumed that I dropped it, and
after all my diligent efforts were exerted by me to locate and recover
the said Driver’s License Card but to no avail and I therefore
considered the same as lost and no longer could be recovered;

3. That the said Driver’s License I.D. Card was never been used as a
collateral for loan nor been involved in any crime, it was accidentally
dropped, lost and or misplaced while I was travelling on my
passenger jeepney/jitney;

4. That I am executing this Affidavit of loss to attest to the truth of the

foregoing facts and circumstances and as for in compliance to the
requirements of the LAND TRANSPORTATION OFFICE (LTO) and any
government agencies and institution to secure the replacement
approval of the above mentioned Driver’s License Card and as well
for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I hereunto affix my signature this ____day of

__________at Quezon City, Philippines.

_________________________
Affiant

SUBSCRIBED AND SWORN to before me this ____day of __________at

Quezon City, Philippines.