Republic of the
Philippines )
City of Cebu )
S.S
AFFIDAVIT OF LOSS OF DRIVER'S LICENSE
I, (NAME OF AFFIANT), of
legal age, Filipino, single/married, and a resident of (Place of Residence), after
having been duly sworn to according to law hereby depose and state that:
1. I was a holder of a Driver’s License
issued by the Land Transportation Office;
2. Sometime on January 16, 2019, I
discovered the loss of said Driver’s License while I was sifting through my
personal belongings where as I can recall I kept my Driver’s License but I
could not locate the said Driver’s License;
3. I tried to look for the said Driver’s
License in my wallet and in other parts of the household but despite diligent
search and efforts to locate the said Driver’s License, I could not find it
such that I now believe that I misplaced it and it is now lost beyond recovery;
4. Said lost Driver’s License was not
confiscated by any officer of the law or agency by reason of any violation of
any law, ordinance, presidential decree or rules and regulation of said agency,
and neither was it given to any person;
5. As such, I am executing this Affidavit
of Loss to attest to the truth of the foregoing and for whatever legal purpose
it may serve.
IN WITNESS WHEREOF, I have hereunto set my
hand this (Date) at (Place), Philippines.
(NAME OF AFFIANT)
SUBSCRIBED AND SWORN TO BEFORE ME this (Date)
in the City of (Place), Philippines by (Name of Affiant) who presented her ____________ ID No. _______________
which was issued/expires on _______________
at _______________, a government-issued identification card bearing her signature and photograph.
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of _____.
