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(Affidavit of Loss Pawnshop Ticket)

Republic of the Philippines)


Province of ____________________)S.S.
City/Municipality of _____________)
x---------------x
AFFIDAVIT OF LOSS
I, _____________, Filipino, of legal age, (single / married / widow), and a
resident of _____________, Philippines, after being duly sworn in
accordance with law, depose and state:
That sometime on _____________, I pawned my _____________ with
Agencia _____________ located at _____________ and for which I was
issued Pawn Tickets / Receipt No. _____________.

That sometime on _____________, my wallet that contains the said Pawn


Ticket was misplaced and got lost.

That despite diligent search and efforts to locate the said wallet and pawn
ticket, I could not find the same such that I now believe that they are now
lost beyond recovery.

As such, I am executing this Affidavit of Loss to attest to the truth of the


foregoing facts.
IN WITNESS WHEREOF, I have hereunto set my hand this _____________
at _____________, Philippines.
Affiant

(JURAT)
REPUBLIC OF THE PHILIPPINES)
CITY OF MAKATI ) S.S.
x----------------------------x

AFFIDAVIT OF LOSS

I, ___________________, of legal age, Filipino, (single/married/widow)


and a resident of _______________________________, after having been
duly sworn to in accordance with law, depose and state THAT:

1. I am a duly-licensed driver in accordance with pertinent Land Transportation


laws, rules and regulations, and was issued a corresponding (Non)
Professional Driver's License with number _____________ which is valid
until _____________;

2. Sometime on ____________, said driver's license was misplaced and got


lost;

3. 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;

4. Said Driver's License has not been confiscated by the LTO, Police or other
Traffic Enforcers for any traffic violation;

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 (Non)
Professional Driver's License, in lieu of the one that was lost;

IN WITNESS WHEREOF, I have hereunto set my hand


this ___________________ in Makati City, Metro Manila, Philippines.
____________________

Affiant

SSS ID No. _____________

SUBCRIBED AND SWORN TO before me


this ___________________ in _________________, Philippines, affiant
exhibiting to me his/her competent evidence of identity by way of
__________________ issued at ______________
on __________________.

Doc. No. _____;


Page No. _____;
Book No. _____;
Series of 2013.

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