(REPUBLIC OF THE PHILIPPINES
CITY OF NAGCARLAN) Sc.
x------------------------------------------x
AFFIDAVIT
I, LIAN FORMELOZA , Filipino, of legal age, single and a resident of Nagcarlan,
after being duly sworn to in accordance with law, depose and state that:
1. As a licensed driver, I was issued a Corresponding Non-Professional Driver’s
License with No. D17-28-302320
2. On or about February 7, 2021, I discovered that my said license was missing
and I exerted all efforts to locate the same but I could no longer find it;
3. Said license has not been confiscated by any officer of the law or by the officers
of Police or Traffic Enforcers for violation of any law, ordinance, decree or the
rules and regulations of LTO;
4. As all diligent search and efforts to find the same proved futile, it is now safe to
assume that said license is now lost beyond recovery;
5. As such, I execute this affidavit to attest to the truth of the foregoing facts, to
support my application for the issuance of a new Non-Professional Driver’s
License, and for whatever legal purpose that this affidavit may serve;
6. FURTHER AFFIANT SAYETH NAUGHT.
IN WITNESS WHEREOF, I have hereunto set my hand this 8th day of February,
2021 in The City of Nagcarlan, Philippines.
LIAN FORMELOZA
_____________________________
AFFIANT
SUBSCRIBED and sworn to before me on the date and place first above written
by the above-named Affiant whom I have identified through his Voter’s ID which is
valid until 2023.
NOTARY PUBLIC
Doc. No. _____;
Page No. _____;
Book No._____;
Series of 20___.
CITY OF NAGCARLAN) Sc.
x------------------------------------------x
AFFIDAVIT
I, LIAN FORMELOZA , Filipino, of legal age, single and a resident of Nagcarlan,
after being duly sworn to in accordance with law, depose and state that:
1. As a licensed driver, I was issued a Corresponding Non-Professional Driver’s
License with No. D17-28-302320
2. On or about February 7, 2021, I discovered that my said license was missing
and I exerted all efforts to locate the same but I could no longer find it;
3. Said license has not been confiscated by any officer of the law or by the officers
of Police or Traffic Enforcers for violation of any law, ordinance, decree or the
rules and regulations of LTO;
4. As all diligent search and efforts to find the same proved futile, it is now safe to
assume that said license is now lost beyond recovery;
5. As such, I execute this affidavit to attest to the truth of the foregoing facts, to
support my application for the issuance of a new Non-Professional Driver’s
License, and for whatever legal purpose that this affidavit may serve;
6. FURTHER AFFIANT SAYETH NAUGHT.
IN WITNESS WHEREOF, I have hereunto set my hand this 8th day of February,
2021 in The City of Nagcarlan, Philippines.
LIAN FORMELOZA
_____________________________
AFFIANT
SUBSCRIBED and sworn to before me on the date and place first above written
by the above-named Affiant whom I have identified through his Voter’s ID which is
valid until 2023.
NOTARY PUBLIC
Doc. No. _____;
Page No. _____;
Book No._____;
Series of 20___.
