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.