Affidavit of Loss Drivers License ATM Card etc due to Loss of Wallet

Republic of the Philippines)

Province of ___________)
x-----------------------x

AFFIDAVIT OF LOSS

I, _____________, Filipino, of legal age, (single / married / widow), and a resident of _____________,
Philippines, after being duly sworn to in accordance with law, hereby depose and state:
That I am an employee of _____________ at _____________, Philippines and at the same time a duly-
licensed driver;

That on _____________ at around ________, while I was at the _____________ at _____________, I lost my
wallet which I usually place in my back pocket;
That inside the said wallet are my Driver's License and ATM Card issued by _____________ Bank,
_____________ Branch;

That despite diligent search and efforts to locate the said wallet and my Driver's License and my ATM Card, I
could not find them such that I now believe that they are now lost beyond recovery;
That my 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 and a new ATM Card, in lieu of the ones that were lost.
IN WITNESS WHEREOF, I have hereunto set my hand this _____________ at _____________, Philippines.

Affiant

(JURAT)