Republic of the Philippines }
Tanza, Cavite } s.s.
AFFIDAVIT OF LOSS
I, ______________________, Filipino, of legal age,
(single/married/widow), and with residence address at
______________________________________, after having been
duly sworn in accordance with law, state 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 Driver's License with number
[Driver’s License Number] which is valid until [Expiration Date].
2. On or about [Date of Loss], I discovered that my
aforementioned driver’s license was missing and could no longer be
located despite diligent efforts to find it.
3. The said license may have been lost due to [brief
explanation of the circumstances, e.g., accidental loss during travel,
misplaced while commuting, possible theft, etc.].
4. The said license has not been confiscated by the Land
Transportation Office, Police, or any other traffic enforcement
authority for any traffic violation.
5. I am executing this affidavit to attest to the truthfulness
and veracity of the foregoing statements and to support my
application for a replacement from the Land Transportation Office,
and for any other legal purposes it may serve.
Tanza, Cavite, _______________, 20___.
______________________
This Affidavit of Loss was personally subscribed and sworn to
by ______________________ before me this ________ day of
__________ 20___ in Tanza, Cavite. Affiant, who is personally known
to me, avowed under penalty of law to the whole truth of the contents
thereof. He/She exhibited to me his/her ______________________
with No. __________ which is valid until __________, as competent
proof of his/her identity.
Doc. No.: ___;
Page No.: ___;
Book No.: ___;
Series of 20___.
