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REPUBLIC OF THE PHILIPPINES )

PROVINCE OF NUEVA ECIJA ) S.S.


MUNICIPALITY OF CABIAO )
x- - - - - - - x

AFFIDAVIT OF LOSS

I, FLOYD B. CUNANAN, of legal age, married, Filipino and a resident of Barangay 135
Bonifacio St. Brgy. 3 Laur, Nueva Ecija, after having been duly sworn in accordance with law hereby
depose and say:

That I am a duly-licensed driver in accordance with pertinent Land Transportation laws, rules and
regulations;

That sometime on year 2017, said driver’s license was misplaced and got lost;

That despite diligent efforts exerted, I could no longer locate, find or recover the said driver’s
license, and to the best of my knowledge, the same is truly lost;

That said Driver’s license has not been confiscated by the LTO, Police or other Traffic Enforcers
for any traffic violation;

That I am executing this Affidavit of Loss to attest 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 set my hand this 19th day of June, 2018 here at
Municipality of Cabiao;

FLOYD B. CUNANAN
Affiant
Philippine Passport No. P145178A

SUBSCRIBED AND SWORN to before me on the date and the place above mentioned, Affiant
exhibited to me his Philippine Passport indicated below his name.

Doc. No. ___;


Page No. ___;
Book No. ___;
Series of 2018.

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