Form No.7--Affidavit of Loss Drivers License ATM Card etc due to Loss of Wallet

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Affidavit of Loss Drivers License ATM Card etc due to Loss of Wallet

Republicof the Philippines)
Province of____________________)
S.S.
City/Municipality of _____________)
x - - - - - - - - - - - x

AFFIDAVIT OF LOSS

I,_____________, Filipino, of legal age, (single/married / widow), and a resident of _____________, Philippines, after being duly sworn to in accordance with law, hereby depose and state:

That I am an employee of_____________at____________, Philippines and at the same time a duly-licensed driver;

That on____________at around________,while I was at the____________at_____________, I lost my wallet which I usually place in my back pocket.

That inside the said wallet are my Driver's License and ATM Card issued by_____________ Bank,____________Branch

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

That my Driver's License has not been confiscated by the LTO, Police or other Traffic Enforcers for any traffic violation.

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 hereunto set my hand this_____________at_____________, Philippines.

Affiant

(JURAT)