REPUBLIC OF THE PHILIPPINES)

CEBU CITY
) S.S.
x----------------------------------x

AFFIDAVIT OF LOSS
I, MARK JEEG C. JAMIN, of legal age, Filipino, single and a resident of C7 Executive
Village, Labangon, Cebu City, Philippines, after having been duly sworn to in accordance
with law, depose and state THAT:
1. I am the son of MANUEL C. JAMIN, registered owner of a Hyundai Accent 2014
model, with plate number AAE 7459;
2. The said automobile unit has its own car service passport issued together with its
purchase for servicing and maintenance purposes of such unit;
3. Upon the need of such car service passport, It was inadvertently lost and nowhere to
be found;
4. Despite diligent search and earnest efforts to locate the said service passport, I could
not find the same such that I am now in honest belief that it was lost beyond
recovery;
5. In the event that the lost car service passport should hereafter be found or
recovered, I undertake to forward or surrender the same to Hyundai Service Office
for appropriate disposal;
6.

As such, I am executing this affidavit to attest to the foregoing facts and to support
the application for the issuance of a new one in lieu of the one which was lost.

AFFIANT FURTHER SAYETH NAUGHT

IN WITNESS WHEREOF, I have hereunto set my hand this ___th day of January 2016 in
Cebu City, Cebu, Philippines.

____________________
Affiant
Drivers License Number: G14-14-00636

SUBCRIBED
AND
SWORN
TO before
me
this ___________________ in
_________________, Philippines, affiant exhibiting to me his valid proof of identification.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2016.