Affidavit of Mutilation

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Republic of the Philippines)

Province of Iloilo )
Municipality of Guimbal ) S.S
x-------------------------------------x

AFFIDAVIT OF MUTILATION OF DRIVER’S LICENSE

I, DOMINGO N. PASTOLERO, of legal age, Filipino, widower, and


presently residing at Barangay Sapa, Miagao, Iloilo, after having been duly sworn
to in accordance with law do hereby depose and say:

1. That I am a holder of a Driver’s License with No. N26-19-003443;

2. That the said Driver’s License was damaged or mutilated;

3. That the damage on the said Driver’s License has rendered it unusable;

4. That I am humbly requesting that the Land Transportation Office will


issue a replacement of the said Driver’s License in my favor.

5. I am executing this Affidavit to attest to the truthfulness of the foregoing


statement.

IN WITNESS WHEREOF, I have hereunto set my hand and signature this


10 March 2023, Guimbal, Iloilo, Philippines.

DOMINGO N. PASTOLERO
Affiant
OSCA NO. 7661

SUBSCRIBED AND SWORN TO before me this March 10, 2023 at


Guimbal, Iloilo, Philippines.

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