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.