REPUBLIC OF THE PHILIPPINES)

Baguio City ) SS.

AFFIDAVIT OF LOSS

I, MARTIN B. PAPAY JR., Filipino, married, of legal age, and a resident of Block 5,
Lot 15, White Woodmilk Street, Phase 3, Richgate 2, Camp 7, Baguio City after having
been duly sworn in accordance with law, hereby depose and say:

1. That I am the registered owner of a Mitsubishi Van 2003 Model more particularly
described as follows:

Make: MITSUBISHI Serial No.: W5036310

Model: 2003 Motor No.: 4G64AO33138
Type: Van Plate No.: XME599
File: 1391-00000004726

2. That the Certificate of Registration (CR) of the aforesaid vehicle under my name has
the following CR Number: 4422927-5;

3. That sometime in January 2017, when I was delivering the vehicle to my sister Grace
May P. Castro, I discovered that the original copy of the Certificate of Registration (CR)
was missing and was possibly misplaced;

4. Despite diligent search and efforts to locate said document, I could not find it;

5. That I am executing this affidavit to attest to the truth of the foregoing facts and to
request for are replacement of said document.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 18th day of May
2017 at Baguio City, Philippines.

MARTIN B. PAPAY JR.

Affiant

SUBSCRIBED AND SWORN TO before me, a notary public in and for Baguio City this
18th day of May 2017. The affiant, whom I identified through his Professional
Identification Card, issued on June 6, 2013 by the Professional Regulation Commission,
and valid until October 25, 2020, personally signed the foregoing instrument before me
and avowed under penalty of law to the whole truth of the contents of said instrument.

Doc. No._____;
Page No. _____;
Book No._____;
Series of 2017.