REPUBLIC OF THE PHILIPPINES…)

SIQUIJOR, SIQUIJOR )
x……………………………………………x

AFFIDAVIT OF LOSS

I, NOLE R. TORRES, Filipino, of legal age, single and with residence at Cangbagsa,
Larena, Siquijor after duly sworn to in accordance with law, hereby depose and state THAT:

1. I am a duly-licensed driver in accordance with pertinent Land Transportation

laws, rules and regulations, and was issued a corresponding Professional Driver’s
License with number G02-12-001039 which is valid until November 24, 2022;

2. Sometime on October 22, 2022, said driver’s license was misplaced and got lost;

3. Efforts were exerted to locate 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 Traffic
Enforcer for any traffic violation;

5. As such, I am executing this Affidavit of Loss to attest the truth of the foregoing
and to support my application for the issuance of a new Professional Driver’s
License, in lieu of the one that was lost.

IN WITNESS WHEREOF, I have hereunto set my hand this 28 th day of October 2022 in
Siquijor, Siquijor, Philippines.

NOLE R. TORRES
Affiant

SSS ID NO. 07-3301277-6

SUBCRIBED AND SWORN TO before me this ________ of October, 2022 in Siquijor,

Philippines, affiant exhibiting to me his competent evidence of identity by way of SSS ID NO.
07-3301277-6.