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Affidavit of Loss (Sample 2)

This affidavit describes how the affiant lost their driver's license on December 13, 2014 in Makati City, Philippines. While getting into their car, their wallet containing the license fell out of their pocket onto the street. They only realized it was missing later that night upon returning home to Marikina City. Efforts to retrieve the lost license were unsuccessful. The affiant is submitting this affidavit to request a replacement license from the Land Transportation Office and for any other legal purposes.

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JJ Castro
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1K views1 page

Affidavit of Loss (Sample 2)

This affidavit describes how the affiant lost their driver's license on December 13, 2014 in Makati City, Philippines. While getting into their car, their wallet containing the license fell out of their pocket onto the street. They only realized it was missing later that night upon returning home to Marikina City. Efforts to retrieve the lost license were unsuccessful. The affiant is submitting this affidavit to request a replacement license from the Land Transportation Office and for any other legal purposes.

Uploaded by

JJ Castro
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Republic of the Philippines )

___________ ) SS

AFFIDAVIT OF LOSS

I, _________________________, of legal age, Filipino citizen, and with postal


address at ____________________________________, after having been duly sworn to in
accordance with law hereby depose and state:

1. That I am a holder of a Driver’s License issued by the Land Transportation


Office.

2. That on 13 December 2014, in Makati, at, about eleven o’clock in the


evening (11:00 pm), while on my way inside my car, my wallet containing the said
Driver’s License slipped from my pocket and fell on the street.

3. That I only realized the said incident when I got to my aforementioned


residential address in Marikina.

4. That I went back to Makati but the said Driver’s License was lost and
could no longer be found and efforts were exerted by the herein affiant to retrieve
the same, but in vain.

5. That the said Driver’s License is not under the custody of any government
agency.

6. That I am executing this affidavit to attest to the truth of the foregoing and
to ask the Land Transportation Office to issue a replacement Driver’s License and
for whatever other legal purpose it may serve.

IN TRUTH WHEREOF, I have hereunto signed my name below, this __ day of


________ ____ in Makati City.

____________________________
Affiant

SUBSCRIBED AND SWORN TO before me this __ day of ______________ 2017 in


Makati, Philippines, affiant exhibiting to me a copy of his Passport (No.
__________________) valid until __ ___________ ______.

Doc No._____;
Page No. ____; NOTARY PUBLIC
Book No. ____;
Series of 2017.

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