Anda di halaman 1dari 2

AFFIDAVIT OF LOSS

REPUBLIC OF THE PHILIPPINES}


CITY OF ZAMBOANGA . . . } S.C.
X----------------------- /
I, LILA MAE CRUZ, of legal age, Filipino citizen, single, with residence and
post office address at Picnic Ground, Tugbungan, Zamboanga City, Philippines, after
being duly sworn to in accordance with law, hereby depose and state:
That I am currently enrolled with the Ateneo de Zamboanga University; That I am
a Fourth Year student, taking up Bachelor of Science in Business Management;
That I was duly issued Non- Professional Drivers License by the Land
Transporation Office of Zamboanga City;
That I kept the herein-mentioned Drivers License in my wallet including other
pertinent papers;
That on February 11, 2009 around 11:30 in the morning, I went to the branch
office of Land Transportation Office at Yubengco located at Putik, Zamboanga City to
renew my drivers license; I noticed that my wallet was no longer inside my pocket;
That I have exerted repeated diligent effort to locate the herein mentioned NonProfessional Drivers License, which have, unfortunately, been to no avail; That I
immediately conducted a thorough search of my things and other belongings; That, I
unfortunately, all my efforts were in vain;
That I am freely and voluntarily executing this Affidavit to state the truth of the
facts relating to the loss of the mentioned Non- Professional Drivers License for the
purpose of acquiring new Non-Professional Drivers License from the Land
Transportation Office in Zamboanga City.
IN WITNESS WHEREOF, I have hereunto set my hand this 23 rd day of January
2009 at Zamboanga City, Philippines.

LILA MAE CRUZ


Affiant

SUBSCRIBED AND SWORN to before me this 13th day of February 2009,


Zamboanga City, Philippines, Affiant exhibiting to me her Community Tax Certificate
No. 65398026 issued on January 5, 2009 at Zamboanga City, Philippines.

Doc. No. __________


Page No. __________
Book No.__________
Series of 2009

ATTY. ELAINE JOY A. FERNANDEZ


Notary Public
Brilliantes Compound, Sta. Maria, Zamboanga City
Commissioned until December 31, 2009
IBP O.R. # 843974, January 02, 2009
PTR O.R # 9743806, January 02, 2009
at Zamboanga City