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Affidavit of Loss

This document is an affidavit of loss for a driver's license. It states that the individual was issued a driver's license with a given number that expired on a certain date. The license was misplaced and lost despite search efforts. The license has not been confiscated. The affidavit is being filed to support an application for a new license to replace the lost one.

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Jim John David
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347 views3 pages

Affidavit of Loss

This document is an affidavit of loss for a driver's license. It states that the individual was issued a driver's license with a given number that expired on a certain date. The license was misplaced and lost despite search efforts. The license has not been confiscated. The affidavit is being filed to support an application for a new license to replace the lost one.

Uploaded by

Jim John David
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
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Drivers Licence

REPUBLIC OF THE PHILIPPINES)


CITY OF MAKATI
) S.S.
x----------------------------x
AFFIDAVIT OF LOSS
I, ___________________, of legal age, Filipino, (single/married/widow) and a resident of
_______________________________, after having been duly sworn to in accordance with law,
depose
and
state THAT:
1. I am a duly-licensed driver in accordance with pertinent Land Transportation laws, rules and
regulations, and was issued a corresponding (Non) ProfessionalDriver's License
with number _____________ which is valid until _____________;
2. Sometime on ____________, 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 for
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;
IN WITNESS WHEREOF, I have hereunto set my hand this ___________________ in
Makati City, Metro Manila, Philippines.
____________________
Affiant
SSS ID No. _____________
SUBCRIBED
AND
SWORN
TO before
me
this ___________________ in
_________________, Philippines, affiant exhibiting to me his/her competent evidence of identity
by way of __________________ issued at ______________ on __________________.
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2013.

Pawnshop
REPUBLIC OF THE PHILIPPINES)
CITY/MUNICIPALITY OF _____ ) S.S.
x-------------------------------------x
AFFIDAVIT OF LOSS
I, ___________________, of legal age, Filipino, single and a resident of
_______________________________, after having been duly sworn to in accordance with law,
depose and state THAT:
1. Sometime on ______________, I pawned my _________ with Tambunting Pawnshop located
at _____________________ and for which I was issued Pawn Ticket/Receipt No. _________;
2. I kept the said pawn ticket in my wallet for safekeeping but unfortunately my wallet got lost;
3. Despite diligent search and efforts to locate the said wallet and pawn ticket, I could not find
the same such that I believe that they are now lost beyond recovery;
4. As such, I am executing this affidavit to attest to the foregoing facts and to enable me to secure
a duplicate or substitute copy of the ticket and/or redeem the above-described item which I
pawned.
IN WITNESS WHEREOF, I have hereunto set my hand this ___________________ in
____________, Philippines.
____________________
Affiant
GSIS ID No. _____________
SUBCRIBED
AND
SWORN
TO before
me
this ___________________ in
_________________, Philippines, affiant exhibiting to me his valid proof of identification.
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2013.

Passport
REPUBLIC OF THE PHILIPPINES)
CITY OF MAKATI
) S.S.
x----------------------------------x
AFFIDAVIT OF LOSS
I, ___________________, of legal age, Filipino, single and a resident of
_______________________________, after having been duly sworn to in accordance with law,
depose and state THAT:
1. On January 12, 2010, I was issued a Philippine Passport by the Department of Affairs in Manila;
2. Recently, I had tried to look for the said passport but the same could not be found;
3. Despite diligent search and efforts to locate the said passport, I could not find the same such that I
believe that it is now lost beyond recovery;
4. As such, I am executing this affidavit to attest to the foregoing facts and to support
the application for the issuance of a new one in lieu of the one which was lost.
IN WITNESS WHEREOF, I have hereunto set my hand this ___________________ in
Makati City, Metro Manila, Philippines.
____________________
Affiant
GSIS ID No. _____________
SUBCRIBED
AND
SWORN
TO before
me
this ___________________ in
_________________, Philippines, affiant exhibiting to me his valid proof of identification.
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2013.

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