REPUBLIKA NG PILIPINAS }

LALAWIGAN NG BULACAN } S.S.

AFFIDAVIT OF LOSS
(MOTOR VEHICLE CERTIFICATE OF REGISTRATION)
I, ______________________________, a Filipino of legal age, single,
and residing at ____________________________________________, after
having been duly sworn in accordance with law, depose and say
that:
1. That I am the registered owner of a certain motorcycle with
side car and with plate number ___________________;
2. That as a registered owner, I was issued a Certificate of
Registration and an Original Receipt for my registration for
the year ______________ by the Land Transportation Office;
3. That when I was about to register said motor vehicle for the
year ________, I could no longer find said Certificate of
Registration of the said motor vehicle;
4. That despite diligent search and efforts to locate the said
documents, I could no longer find the same such that I
believe that they are now lost beyond recovery;
5. 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 new Certificate of Registration, in lieu of the
ones that were lost.
IN WITNESS WHEREOF, I affix
my
__________________, , in _______________________.

signature

this

Affiant
Subscribed and sworn before me this _________________ in
______________.