REPUBLIC OF THE PHILIPPINES)

PROVINCE OF CAVITE

) S.S

CITY OF BACOOR

x-----------x

AFFIDAVIT OF LOSS
I, Percival James Licardo Lacebal, of legal age, Filipino, single and a
resident of Block 29, Lot 31, Queens Row West, Bacoor City, Cavite, after
having been duly sworn to in accordance with law, depose and state:
1.) THAT I am a holder of Voters ID in accordance with COMELEC issued at
Bacoor City, Cavite.
2.) THAT I used to put said Voters ID in my wallet.
3.) THAT Sometime on December 27, 2015, said Voters ID was lost because
my wallet was pick-pocketed without my knowledge while I was busy buying
fruits and vegetables at Molino Wet and Dry Market.
4.) Efforts were exerted to locate said driver's license, but in spite of diligent
search, it could not be found and the same is now beyond recovery;
5.) 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 Voters ID,
in lieu of the one that was lost;

IN WITNESS WHEREOF, I have hereunto set my hand this 28th of

December 2015 in Bacoor City, Cavite, Philippines.
Percival James Licardo Lacebal
Affiant
SUBCRIBED AND SWORN TO before me this 28th day of December,
2015 in City of Bacoor, Province of Cavite, Philippines, affiant exhibiting to
me his competent evidence of identity by way of Community Tax Certificate
No. 23733766 , issued at Bacoor City on 28th day of December 2015.
Doc. No.: _____;
Page No.: _____;
Book No.: _____;
Series of _____

REPUBLIC OF THE PHILIPPINES)

PROVINCE OF CAVITE

) S.S

CITY OF BACOOR

x-----------x

AFFIDAVIT OF LOSS
I, Percival James Licardo Lacebal, of legal age, Filipino, single and a resident
of Block 29, Lot 31, Queens Row West, Bacoor City, Cavite, after having been duly
sworn to in accordance with law, depose and state:
1.)

THAT

I am

duly-licensed

driver

in

accordance

with

pertinent

Land

Transportation laws, rules and regulations, and was issued a corresponding NonProfessional Driver's License with number N26-08-009662 which is valid until
December 17, 2016;
2.) THAT I used to put said Drivers License in my wallet.
3.) THAT Sometime on December 27, 2015, said driver's license was lost because
my wallet was pick-pocketed without my knowledge while I was busy buying fruits
and vegetables at Molino Wet and Dry Market.
4.) Efforts were exerted to locate said driver's license, but in spite of diligent search,
it could not be found and the same is now beyond recovery;
5.) Said Driver's License has not been confiscated by the LTO, Police or other
Traffic Enforcers for any traffic violation;
6.) 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 Non- Professional
Driver's License, in lieu of the one that was lost;
IN WITNESS WHEREOF, I have hereunto set my hand this 28th of December
2015 in Bacoor City, Cavite, Philippines.
Percival James Licardo Lacebal
Affiant
SUBCRIBED AND SWORN TO before me this 28th day of December, 2015 in
City of Bacoor, Province of Cavite, Philippines, affiant exhibiting to me his
competent evidence of identity by way of Community Tax Certificate No. 23733766 ,
issued at Bacoor City on 28th day of December 2015.

Doc. No.: _____;

Page No.: _____;

Book No.: _____;
Series of _____