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REPUBLIC OF THE PHILIPPINES )

CITY OF San Fernando ) S.S.

AFFIDAVIT OF LOSS

I, AARON BRENDO ATIENZA y ABEDOZA, Filipino, of legal age,


residing at 12586 Sampaloc St., Dau Homsite, Dau, Mabalacat,
Pampanga, after having been sworn in accordance with law
hereby depose and state:

1. I am the owner of a Professional driver's license issued by


the Land Transportation Office (LTO).
2. Sometime in February of this year, I was looking for the said
driver's license, but to my surprise, the same could not be
found;
3. I took pains to look for said license, but to no avail;
4. Hence, I am now applying for the issuance of my driver's
license due to "lost licence".

That I am executing this affidavit to attest to the truth of


the foregoing and to request from the Land Transportation Office,
for the issuance of new license.

IN WITNESS WHEREOF, I have hereunto set my hand this


________ 2016 day at San Fernando City.

AARON BRENDO ATIENZA


AFFIANT

SUBSCRIBED AND SWORN to before me, this _______ 2016


San Fernando City, with affiant exhibiting his valid proof of
identity.

NOTAR
Y PUBLIC

Doc. No. :
Page No. :
Book No. :
Series of 2016.

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