Anda di halaman 1dari 1

REPUBLIC OF THE PHILIPPINES)

CITY OF VALENZUELA
) S.S.
AFFIDAVIT OF LOSS
I, DANTE N. LAVARO of legal age, Filipino and a resident of 100 J. Santiago St.
Malanday Valenzuela City, after having been duly sworn to in accordance with law do
hereby depose and state that:
1.

I am the true and lawful holder of a Temporary Drivers License issued by the
Land Transportation Office;

2.

That sometime January 8, 2016 when I arrived home from work, I found out
that my wallet was lost together with some pertinent identification cards as well
as my drivers license;

3. Diligent efforts were exerted by the herein affiant to recover the same but to no
avail the said drivers license is now beyond recovery and thus considered lost
for all purposes;
4. I am executing this affidavit to attest to the truth of all the foregoing and for
whatever legal purpose this affidavit may serve.
IN WITNESS WHEREOF, I have hereunto signed this document this 11th day of
January 2016 hereat City of Valenzuela.

DANTE N. LAVARO
Affiant

SUBSCRIBED AND SWORN to before me this 11th day of January 2016 hereat
Valenzuela City.

Anda mungkin juga menyukai