REPUBLIC OF THE PHILIPPINES )

MAKATI CITY ) S.S.

AFFIDAVIT OF LOST

I, _____________________________ of legal age and with postal address at _____________________

have been duly sworn to in accordance with law do hereby depose and say;

1. That I am the lawful/registered owner of a motor vehicle, more particularly described as follows:

Make :
Motor no. :
Chassis no. :
MV file :
Plate no. :

2. That sometime in 2016, the original copy of the said certificate of registration could not be fond
and that despite of diligent search and efforts, could no longer be found such that I now believe
that it is now lost beyond recovery.

3. That I am executing this affidavit of lost to attest the truthfulness of all foregoing and for
whatever legal purposes that this may serve.

In WITNESS WHEREOF, I have hereunto affixed my signature this __th of _______________ in

Makati City.

__________________
Affiant

SUBSCRIBED AND SWORD to before me this __th day of ________________ in Makati City.
Doc No. _______
Page no. _______
Book of ________
Series of _______