Scribd
Upload
14 views2 pages

Form No.1: Affidavit of Loss

Jasmine A. Peralta executed an affidavit of loss to attest that her driver's license was misplaced and lost in December 2020 despite diligent search efforts. She states she holds a valid non-professional driver's license that has not been confiscated for any traffic violations. The affidavit supports her application for a new driver's license to replace the lost one.

Uploaded by

Diana Rose Dalit
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
14 views2 pages

Form No.1: Affidavit of Loss

Jasmine A. Peralta executed an affidavit of loss to attest that her driver's license was misplaced and lost in December 2020 despite diligent search efforts. She states she holds a valid non-professional driver's license that has not been confiscated for any traffic violations. The affidavit supports her application for a new driver's license to replace the lost one.

Uploaded by

Diana Rose Dalit
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
You are on page 1/ 2

FORM NO.

1: AFFIDAVIT OF LOSS

REPUBLIC OF THE PHILIPPINES)


PROVINCE OF LA UNION ) S.S
CITY OF SAN FERNANDO )

AFFIDAVIT OF LOSS

I, JASMINE A. PERALTA, of Legal Age, Filipino, Single, and a resident of Brgy.


Lingsat, City of San Fernando, La Union, subscribing under oath, hereby depose and state:

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
E16-05-301615 which is valid until February 18, 2022;
2. Sometime in December 2020, said driver’s license was misplaced and got lost;
3. Efforts were exerted to locate said driver’s license, but in spite of diligent search, it could not be
found and the same is now beyond recovery;
4. Said driver’s License has not been confiscated by the LTO, Police or other Traffic Enforcers fir
any traffic violation;
5. 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;

JASMINE A. PERALTA

Affiant

________________________________________

________________________________________
BEFORE ME, appears the person of JASMINE A. PERALTA presenting the above
Affidavit, who is personally known to me or identified by me through competent evidence of
identity as defined by the Notarial Rules as the person who signs the document and in my
presence taken an oath or affirmation before me as to such document.

You might also like