________________)________________)S.S________________)

AFFIDAVIT OF LOSS

I, ________________, of legal age, Filipino Citizen, single/married, and a resident of ___________________________, after having been duly sworn to in accordance with law, depose and say:1. That I am the same person executing this affidavit;

2. That I am an owner of a Professional Drivers License duly issued by the Land Transportation Office;

3. That however on __________________________, I shockingly noticed that the said license were no longer inside my pocket hence I exerted my best effort to locate the above-mentioned license, but all my efforts were in vain;

4. That the said Professional Drivers License is now considered lost and beyond recovery;

5. That I am executing this affidavit to attest to the truthfulness and veracity of the foregoing statement and for whatever lawful purpose that it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of _______________ at ______________________.

Affiant

SUBSCRIBED AND SWORN to before me this ___ day of ___________, __________at City of Ilagan, Isabela.

Doc. No. _____Page No. _____Book No. _____Series of _____