REPUBLIC OF THE PHILIPPINES
__________________________)S.S.
X-----------------------------------------X
                        AFFIDAVIT OF MUTILATION OF DRIVER’S LICENSE
       I, JOV ABAPO SEVILLES JR., of legal age, Filipino citizen, and presently residing at
Purok 5, San Miguel, Tagum City, Davao Del Norte, after having been duly sworn to in
accordance with law, do hereby depose and say:
        1. That I am a holder of a Driver’s License with No. L06-11-000918;
        2. That the said Driver’s License was damaged or mutilated;
        3. That the damage on the said Driver’s License has rendered it unusable;
        4. That I am humbly requesting that the Land Transportation Authority will issue a
        replacement copy of Driver’s License in my favor.
        That I am executing this affidavit to attest to the truth of all the foregoing declarations
and for whatever legal purpose this may serve.
      IN WITNESS WHEREOF, I have hereunto set my hand this____ day of
_________________, in the _________________________________, Philippines.
                                    JOV ABAPO SEVILLES JR
                                            Affiant
SUBSCRIBED AND SWORN to before me this _________________________ day of
_________________ in ___________________. Affiant exhibited to me his competent true
identity.
Doc No. _______;
Page No._______;
Book No._______;
Series of _______;