Sie sind auf Seite 1von 2

Republic of the Philippines )

City of Calbayog, Samar ) s.s.

AFFIDAVIT OF LOSS
(Re: Driver’s License)

I, GEORGE MICHAEL TOCAYON FORTUNA, Filipino, 33 years


of age, with common-law partner, and presently residing at Barangay
Hamorawon, Calbayog City, Samar, Philippines, after having been duly
sworn to in accordance with law, hereby depose and state, that--

1. I am a holder of a Professional Driver’s License duly issued


by the Land Transportation Office (LTO) of Calbayog City, with
License Number H01-14-002539;

2. Just recently, my wallet where the said license card including


my other identification cards, was lost, without my knowledge;

3. The moment I learned about it, I exerted diligent efforts to


locate the same, but to no avail;

4. The said Driver’s License was not confiscated nor apprehended


by proper authorities in any violation of law or ordinance or
rules;

5. I am executing this Affidavit to attest to the truth of the


foregoing facts and to support my application for the issuance
of a new Driver’s License Card and for whatever legal purpose
this may serve;

IN WITNESS WHEREOF, I have hereunto set my hand this 10th


day of October 2019, at Calbayog City, Samar, Philippines.

GEORGE MICHAEL TOCAYON FORTUNA


Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, 10th day of October


2019, at Calbayog City, Samar, Philippines.

ATTY. ALJUN B. DIAZ


Public Attorney I
Pursuant to RA 9406
Republic of the Philippines )
City of Calbayog ) s.s.

AFFIDAVIT OF LOSS
(Re: Driver’s License)

I, ARNOLD PALLONES VELASCO, Filipino, 30 years of


age, with common-law partner and presently a
resident of Barangay Malopalo, Calbayog City, Samar,
Philippines, after having been duly sworn to in accordance
with law, hereby depose and state, that--

1. I am a holder of a Professional Driver’s License duly


issued by the Land Transportation Office (LTO) of
Calbayog City, with License Number H0619002165;

2. Just recently, my wallet where the said license card


including my other identification cards, was lost,
without my knowledge;

3. The moment I learned about it, I exerted diligent


efforts to locate the same, but to no avail;

4. The said Driver’s License was not confiscated nor


apprehended by proper authorities in any violation of
law or ordinance or rules;

5. I am executing this Affidavit to attest to the truth


of the foregoing facts and to support my application
for the issuance of a new Driver’s License Card and
for whatever legal purpose this may serve;

IN WITNESS WHEREOF, I have hereunto set my hand this 20th


day of May 2019, at Calbayog City, Samar, Philippines.

ARNOLD PALLONES VELASCO


Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, 20th day of May 2019,


at Calbayog City, Samar, Philippines.

ATTY. LOUIE O. SAJONIA


Public Attorney II
Pursuant to RA 9406