Republic of the Philippines )

Province of Bohol
) S.S.
Municipality of Talibon
)

AFFIDAVIT OF LOSS
I, ______________, Filipino, of legal age, and a resident of ______________, after being duly
sworn to in accordance with law, hereby depose and state:
1. That 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;
2. That my Professional Driver's License was misplaced and got lost;
3. That despite diligent search and efforts to locate my Professional Driver's License, I could not
find the same such that I now believe that it is now lost beyond recovery;
4. That said Professional Driver's License has not been confiscated by the LTO, Police or other
Traffic Enforcers for any traffic violation;
5. 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 Professional Driver's License, in lieu of the
one that was lost.
IN WITNESS WHEREOF, I have hereunto set my hand this ____________ at _____________,
Philippines.

_________________________

Affiant
SUBSCRIBED AND SWORN to before me, this ___________ at ___________________,
Philippines.