Republic of the Philippines ]

Province of Bukidnon ] s.s.

Malaybalay City ]

AFFIDAVIT OF LOSS

I, ANTONIO R. GONZALES, of legal age, married, Filipino citizen,

and resident of Alanib, Lantapan, Bukidnon, after having been duly
sworn to in accordance with law, state:

1 That, I am the registered owner of Strada Pick up with

Certificate of Registration no. 61723675 which was issued by
the Land Transportation office on August 9, 2001 ;

2 That, the said Certificate of Registration was kept along with my

personal records at home at Alanaib, Lantapan, Bukidnon;

3 That, when I searched for the original Certificate of Registration

of my vehicle, I just noticed that it was misplaced along with my
personal records at home;

4 That, despite all diligent efforts having been exerted, I failed to

find the same until now, thereby prompting me to believe that it
is already lost beyond recovery;

5 And that, I execute this affidavit to attest to the truth of the

foregoing statement and for whatever legal purposes it may best
serve.

IN WITNESS WHEREOF, I hereby affix my signature this ____ day

of December 2016 in the City of Malaybalay, Bukidnon, Philippines.

ANTONIO R. GONZALES
[Affiant]
Drivers License No. : K03-00-048728
Issued by :Land Transportation Office

SUBSCRIBED AND SWORN to before me this ______ day of

December 2016 in the City of Malaybalay, Bukidnon, Philippines.

Doc. No. ____

Page No. ____
Book No. ____
Series of 2016