REPUBLIC OF THE PHILIPPINES ) ________________ ) S.S.

AFFIDAVIT OF LOSS
I, _____________, Filipino, of legal age, (single / married / widow), and with residence at _____________, Philippines, after being sworn in accordance with law, states that: 1. I am a duly-licensed driver in accordance with pertinent Land Transportation laws, rules and regulations, and was issued a corresponding Driver's License with number _____________ which is valid until _____________; 2. Sometime last week, my wallet containing said Driver's License was stolen and got lost. 3. Despite diligent search and efforts to locate my Driver's License, I could not find the same such that I now believe that it is now lost beyond recovery; 4. Said Driver's License has not been confiscated by the Land Transportation Office (LTO), Police or other Traffic Enforcers for any traffic violation. 5. 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 Driver's License, in lieu of the one that was lost. IN WITNESS WHEREOF, I affix my signature this ____ day of ____________________ 20__ at _____________________.

Jomar Aunario Affiant

SUBSCRIBED AND SWORN TO BEFORE ME this ___ day of ______________ 20__ at ________________________________, affiant exhibiting before me his/her CTC No. _________________ issued at __________________ on ___________ 20__.

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