Affidavit of Loss - Driver's License

REPUBLIC OF THE PHILIPPINES) CITY OF MAKATI ) S.S. x----------------------------x

AFFIDAVIT OF LOSS  I, ______________ ___________________  _____ , of legal age, Filii!o, "#i!gle$%a&&ie'$(i'o()

a!' a &e#i'e! of ********************* ******************************* **********,, afe& +ai!g + ai!g ee! 'l/ #(o&! o i! a00o&'a!0e (i+ la(, 'eo#e a!' #ae THAT1

2. I a% a 'l/ 'l/--li0e li0e!# !#e' e' '&i '&ie& e& i! a00o& 00o&'a 'a!0 !0e e (i+ i+ e&i e&i!e !e! ! La La!' !' T&a!#o&aio! la(#, &le# a!' &eglaio!#, a!' (a# i##e' a 0o&&e#o!'i!g "No!) P&ofe##io!al P&ofe##io!al 3&ie&4# 3&ie&4# Li0e!#e (i+ !%e& *********** ************* ** (+i0+ i# ali' !il *************5 *************5 6. So%ei%e o! ************, #ai' '&ie&4# li0e!#e (a# %i#la0e' a!' go lo#5 7. Effo&# (e&e exe&e' exe&e' o lo0ae #ai' '&ie&4# '&ie&4# li0e!#e,  i! #ie of 'ilige! #ea&0+, i 0ol' !o e fo!' a!' +e #a%e i# !o( e/o!' &e0oe&/5 8. Sai' 3&ie&4# Li0e!#e +a# !o ee! 0o!fi#0ae' / +e LTO, Poli0e o& o+e& T&affi0 T&affi0 E!fo&0e&# fo& a!/ &affi0 iolaio!5 9. A# #0+, I a% exe0i!g +i# Affi'ai of Lo## o ae# o +e &+ of +e fo&egoi!g a!' o #o& %/ ali0aio! fo& +e i##a!0e of a !e( "No!) P&ofe##io!al 3&ie&4# Li0e!#e, i! lie of +e o!e +a (a# lo#5 I +ae +e&e!o #e %/ +a!' WITNESS WHEREOF, +i# _____________  ___________________ ______ i! Ma:ai Ci/, Me&o Ma!ila, P+ilii!e#. IN

 ____________________   ______________ ______ 

Affia! SSS I3 No. *************

 i! SUBCRIBED AND SWORN TO  efo&e %e +i#  ___________________   ___________________  i!  *****************,  *****************, P+ilii!e#, affia! ex+iii!g o %e +i#$+e& 0o%ee! ei ei'e!0 e!0e of i'e!i/ i/ / (a/ of ****************** i##e' e' a  **************  ************** o! ******************. ******************. 3o0. No. *****5 Page No. *****5 Boo: No. *****5 Se&ie# of 6;27.