REPUBLIC OF THE PHILIPPINES )
City of Toledo …………………………………) S.S.
x-----------------------x
                             AFFIDAVIT OF LOSS
       I, __________________, of legal age, Filipino, and a resident of Langub, Asturias, Cebu,
after having been duly sworn to in accordance with law, hereby depose and state:
        That I am a holder of a Driver’s License validly issued by the Land Transportation’s
           Office;
        That unfortunately, due to inadvertence, the said Driver’s License could no longer be
           found;
        That despite diligent search and efforts, said document could no longer be located such
           that I believe it is now lost beyond recovery;
        As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing
           statements for whatever legal purpose this may serve.
       IN WITNESS WHEREOF, I have hereunto set my hand this 17 February 2015 at
Toledo City, Philippines.
                               ___________________________
                                          Affiant
       SUBSCRIBED AND SWORN to before me, this 17 February 2015, by the Affiant who is
known to me through his competent evidence of identity above-described.
Doc. No. ______;
Page No. ______;
Book No.______;
Series of 2015.