Affidavit of Loss: Republic of The Philippines) City of Talisay, Cebu) S - S

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REPUBLIC OF THE PHILIPPINES)

CITY OF TALISAY, CEBU ) S . S.

AFFIDAVIT OF LOSS

I _________, Filipino, of legal age, and a resident of _________, City of _____,


Philippines, having been duly sworn in accordance with law, hereby depose and
state:
1. That I am an employee of _______________, City of _______, Philippines
and at the same time a duly-licensed driver;
2. That on _________, 2020, at around __________ in the evening, while I
was at the bus station, I lost my wallet which I usually place in my back pocket;
3. That inside the said wallet are my Driver's License and ATM Card issued
by Malayan Bank;
4. That despite diligent search and efforts to locate the said wallet and my
Driver's License and my ATM Card, I could not find them such that I now believe that
they are now lost beyond recovery;
5. That my Driver's License has not been confiscated by the Land
Transportation Office (LTO), Philippine National Police (PNP), or other Traffic
Enforcers for any traffic violation; and
6. 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
and a new ATM Card, in lieu of the ones that were lost.

IN WITNESS WHEREOF, I have set my hand this _______ day of _____,


2020, in City of Talisay, Cebu, Philippines.
SUBSCRIBED AND SWORN to before me this day of ________, 2020 the affiant is
personally known to me and exhibiting to me his _______ issued at _________ on __________
and his CTC no. _________ issued at on __________.

ATTY. ARMAND REY P. SABIDO


Notary Public for the City of Talisay
San Isidro, City of Talisay, Cebu,
Philippines
Appointment No. _______
Until December ____
Roll of Attorney No. 75079
PTR No. 3705810;
IBP No. _________;
MCLE Compliance No. ________

Doc No. ________;


Page No. _______:
Book No. _______;
Series of 2020

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