REPUBLIC OF THE PHILIPPINES )

CITY OF MAKATI ) S.S.

AFFIDAVIT OF LOSS

I, __________________, with residence at _________________,

after having been sworn in accordance with law, do hereby depose and state:

1. That the Land Transportation Office issued in my favor a Non-

Professional Driver’s License ID. No. _________, valid until
________;

2. That sometime in August 2019, I noticed that my driver’s license is

missing.

3. That despite diligent efforts, I still cannot find my driver’s license;

hence, I am of the belief that it was lost.

4. I execute this affidavit of loss as a requirement of Land

Transportation Office.

IN WITNESS WHEREOF, this affidavit has been signed on this _____ day of
________________ 2019 in Makati, City.

REPUBLIC OF THE PHILIPPINES )

CITY OF MAKATI ) S.S.

BEFORE ME, a Notary Public and in Makati, on this ___ day of _______
2019, personally appeared __________, exhibiting his Passport No.
__________,valid until __________ at Philippine Embassy - Washington.
Known to me to be the same person who executed the foregoing Affidavit, and
he acknowledged to me that the same is his free and voluntary act and deed.

Witness my hand and seal this ______ day of ____________ 2019.

Doc. No. ;
Page No. ;
Book No. ;
Series of 2019.