Republic of the Philippines……….

)
) S.S.

AFFIDAVIT OF LOSS

I,., of legal age, Filipino Citizen, and a resident of Cawayan, Dalaguete,

Cebu, having been duly sworn to in accordance with law do hereby depose and say
that:

1. I am a duly-licensed driver in the Philippines;

2. As a licensed driver, I was issued by the Land Transportation Office a

Driver’s License with License _which was issued on _;

3. Sometime around August 2018, the motorcycle I owned was stolen as I

parked it along the National Highway i_;

4. My Driver’s License along with the other documents were placed inside
the U-Box of the said motorcycle;

5. After exerting diligent effort to locate it, the same is nowhere to be

found, hence it is now beyond recovery;

6. That my Driver’s License has not been confiscated by the LTO, Police and
other Traffic Enforcers for any traffic violation;

7. I am executing this Affidavit of Loss to attest to the truth of the foregoing

and for whatever legal purpose this may serve.

AFFIANT FURTHER SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto signed my name thi_ )

_
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, a Notary Public in the _ at _

this . Affiant exhibited to me his _ issued at Cebu on _

Doc. No.: _____;

Page No.: _____;
Book No.:_____;
Series of 2019.