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REPUBLIC OF THE PHILIPPINES)

PROVINCE OF CAVITE
) S. S.
MUNICIPALITY OF MENDEZ
)
AFFIDAVIT OF LOSS
I, Azanith Ann B. Payad, of legal age, Filipino, single, and resident of Payapa
Rd., Galicia 3, Mendez, Cavite, after being duly sworn according to law,
hereby dispose that:
1. I am a duly-licensed driver in accordance with pertinent Land
Transportation laws, rules and regulations, and was issued a corresponding
Non Professional Drivers License with number ???? which is valid until ;
2. The said drivers license got lost in my possession on how, when, or which
for which I cannot determine for sure;
3. I took pains, and exerted due diligence and earnest efforts to look and
locate for the above mentioned drivers license but to no avail it could be
found and considers the same is now beyond recovery;
4. Said drivers license has not been confiscated by the LTO, Police, or other
Traffic Enforcers for any traffic violation;
5. In the event that the lost drivers license should hereafter be found or
located, I undertake to forward or surrender the same to the LTO for
appropriate disposal.
6. I am executing this Affidavit of Loss to attest to the truth of the foregoing
statements and to support my application for the issuance of a new Non
Professional Drivers License, in lieu of the one which was lost.
AFFIANT FURTHER SAYETH NAUGHT.
IN WITNESS WHEREOF, I have hereunto set my hand this __ day of January
2016 at Mendez, Cavite.
Azanith Ann B. Payad
Affiant
SUBSCRIBED AND SWORN to before me this __ day of January 2016 in
Mendez, Cavite, Philippines, affiant exhibited to me her Competent Evidence

of identity by way of school I.D. issued at De La Salle University Taft Manila


on
Doc. No: _____;
Page No: _____;
Book No: _____;
Series of _____