Professional Documents
Culture Documents
Affidavit BLANK
Affidavit BLANK
CITY OF ) S.S.
AFFIDAVIT OF LOSS
2. As proof of ownership of the above-described vehicle I was issued by the Land Transportation
Office, Official Receipt (OR) No. _____________;
5. Said documents were not confiscated by any government authorities for violation of R.A. 4136 and
other related laws;
6. I shall assume responsibility or liability if in any event I will use these documents for whatever
illicit transactions;
7. I am executing this affidavit to attest to the veracity of my statements and to support my request
for duplicate copies of the lost MVRR/MVMRR/OR/CR with the Land Transportation Office
(LTO).
IN WITNESS WHEREOF, I have hereunto set my hand this __ day of __________, 2020, in
_______________ City, Philippines.
___________________________
Affiant
SUBSCRIBED AND SWORN to before me this _______________, at _____________ City, Philippines,
affiant exhibiting to me his Driver’s License No. _______________, and known to me to be the same person who
executed the foregoing affidavit, and I have personally examined the affiant and I was convinced that s/he
voluntarily understood the contents thereof.