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Affidavit of Loss for Motorcycle Receipt

Maria Nieva Cuizon Magpulong lost the original receipt for her Suzuki motorcycle with engine and chassis numbers from the Land Transportation Office. She filed an affidavit to attest that despite searching, she was unable to find the missing original receipt. She executed the affidavit to document the loss of the original receipt.

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Charlotte Marie Galinea
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39 views1 page

Affidavit of Loss for Motorcycle Receipt

Maria Nieva Cuizon Magpulong lost the original receipt for her Suzuki motorcycle with engine and chassis numbers from the Land Transportation Office. She filed an affidavit to attest that despite searching, she was unable to find the missing original receipt. She executed the affidavit to document the loss of the original receipt.

Uploaded by

Charlotte Marie Galinea
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd

Republic of the Philippines)

City of Butuan ) S.S.

AFFIDAVIT OF LOSS

I, MARIA NIEVA CUIZON MAGPULONG, Filipino, married,


with address at South Boundary, Tungkop, Minglanilla, Cebu, after having
been duly sworn according to law, hereby depose and say that:

1. I am the registered owner of a motor vehicle, particularly


described as follows:

Make/Type: SUZUKI/MOTORCYCLE
Series: GSX160DEA
Engine No.: BGA1291962
Chassis No.: NG4BA300332

2. I was issued by the Land Transportation Office an original


copy of the Original Receipt for the above mentioned vehicle;

3. However, I discovered that said original copy of the OR were


missing from my files;

3. Despite earnest efforts to locate said receipt, the same could


not be recovered anymore;

4. I am executing this affidavit to attest to the truth of the


foregoing and for whatever purpose that this may serve best.

IN WITNESS WHEREOF, I have hereunto set my hand this day of


________________ at _______________________________.

MARIA NIEVA CUIZON MAGPULONG


Affiant
I.D. Name:

I.D. No.:

SUBSCRIBED AND SWORN TO BEFORE ME this


__________________, affiant exhibiting to me her government issued I.D.
card with her picture and signature appearing thereon.

Doc. No. ______;


Page No. ______;
Book No. ______;
Series of 2019.

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