Republic of the Philippines ) Province of________________ ) S.S.

City/Municipality of_________ ) x- - - - - - - - - - - - - - - - - - - - - -x

AFFIDAVIT OF LOSS OF DRIVERS LICENSE

I, ________________, of legal age, (single/widow/married to _____________________), Filipino citizen, and a resident of _______________, Philippines, after being sworn to in accordance with law, depose and state: That 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 _____________ which is valid until _____________; That sometime last week, said (Non) Professional Driver's License was misplaced and got lost. That despite diligent search and efforts to locate my said Driver's License, I could not find the same such that I now believe that it is now lost beyond recovery; That said Driver's License has not been confiscated by the LTO, Police or other Traffic Enforcers for any traffic violation. As such, 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 (Non) Professional Driver's License, in lieu of the one that was lost. IN WITNESS WHEREOF, I have hereunto affixed my signature this ___ day of ___________, 20____ at Barangay ___________, __________, ____________, Philippines.

_____________________ Affiant

(NOTARIAL OATH)