Affidavit of Loss Drivers License

Republic of the Philippines)

Province of _______________) S.S.
x-----------------------x

-Affidavit of Loss Drivers License

I, _____________, Filipino, of legal age, (single / married / widow), and with residence at _____________,
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 _____________ which is valid until
_____________;

That sometime last week, said Driver's License was misplaced and got lost;

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 _____________ at _____________, Philippines.

AFFIANT

(JURAT)