1.

AFFIDAVIT OF LOSS OF A DRIVER’S LICENSE

Republic of the Philippines )
Quezon City ) S.S.

AFFIDAVIT OF LOSS
KNOW ALL MEN BY THESE PRESENTS:
I, Mateo Prima, of legal age, Filipino, single, and a resident of 654 Dodgers Towers, Diliman,
Quezon City, after having been sworn in accordance with law, hereby deposes and states that:
1. I am a duly-licensed driver in accordance with pertinent Land Transportation laws, rules and
regulations, and was issued a corresponding Non-Professional Driver's License with number D06-18-009381
which is valid until August 12, 2021;
2. Sometime on February 7, 2020 said driver's license was lost when my wallet carrying such driver’s
license was misplaced when I went to South Korea;
3. Efforts were exerted to locate said driver's license, but in spite of diligent search, it could not be
found and the same is now beyond recovery;
4. Said Driver's License has not been confiscated by the LTO, Police or other Traffic Enforcers for any
traffic violation;
5. 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 Non-Professional Driver's License, in lieu of the one that was lost;
IN WITNESS WHEREOF, I have hereunto set my hand this 9 th day of March 2020 in Quezon City,
Metro Manila, Philippines.

(Sgd.) Mateo Prima

Affiant

SUBSCRIBED and SWORN TO before me, in Quezon City, this 9th day of March 2020, the affiant
exhibiting his Postal Identification Card No. PRN 100190723678 P issued by the Post Office at Quezon City on
July 23, 2019.
WITNESS MY HAND AND SEAL.

(Sgd.) ATTY. CARLITA C. SANDOVAL

Notary Public for Quezon City
Appointment No. 123
Until December 31, 2020
Roll No. 12345; 3/12/15
IBP No. 13234/Jan. 1, 2020/Quezon City
PTR No. 31242/Jan. 1, 2020/Quezon City
MCLE No. I – 001122; 9/09/2018
MCLE No. II – 002233; 9/09/2018
Doc. No. 56
Page No. 43
Book No. I
Series of 2020.