Form No.6--Affidavit of Loss Drivers License
(Affidavit of Loss Drivers License)
Republic of the Philippines)
Province of ____________________) S.S.
City/Municipality of _____________)
x - - - - - - - - - x
AFFIDAVIT OF LOSS
I, _____________, Filipino, of legal age, (single /
married / widow), and with residence at
_____________, Philippines, after being duly sworn
to in accordance with law, hereby depose and state:
That I am a duly-licensed driver in accordance with
pertinent Land Transportation laws, rules and
regulations, and was issued a corresponding
Driver's License with number _____________ which is
valid until _____________;
That sometime last week, said Driver's License was
misplaced and got lost.
That despite diligent search and efforts to locate
my Driver's License, I could not find the same such
that I now believe that it is now lost beyond
recovery;
That said Driver's License has not been confiscated
by the LTO, Police or other Traffic Enforcers for
any traffic violation.
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 Driver's
License, in lieu of the one that was lost.
IN WITNESS WHEREOF, I have hereunto set my hand
this _____________ at _____________, Philippines.
AFFIANT
(JURAT)