REPUBLIC OF THE PHILIPPINES

CITY OF GENERAL SANTOS

S.S

AFFIDAVIT OF LOSS
I, REYNOLD P. PANILA, of legal age, Filipino, married and with address
at 004 Oringo Subd., City Heights, General Santos City, after being sworn to in
accordance with law, hereby depose and say;
That I am the lawful owner and possessor of a utility vehicle evidenced
by a Certificate of registration with CR No. 13614224-1 duly issued in my name
on October 06, 2011 by the Land Transportation Office General Santos City;
That the above mentioned certificate of registration was inadvertently lost
sometime in the year 2014 at General Santos City;
That the said lost certificate of registration was not confiscated by any
traffic officer for violation of any traffic laws/rules and regulation, nor used as
a collateral for any debt/obligation;
That I exerted my best effort to recover the same but to no avail;
That the aforementioned certificate of registration was now beyond
recovery.
That I am executing this affidavit to attest to the truth and veracity of the
foregoing statements.

IN WITNESS WHEREOF, I have hereunto set my hand this 17th day of

February, 2015, in the City of General Santos, Philippines.

REYNOLD P. PANILA
Affiant

Driver;s License No. L04-05-000912

SUBSCRIBED AND SWORN to before me, this 17th day of February,

2015 at General Santos City, Philippines.

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