Republic of the Philippines)

City of Davao )S.S.

x------------------------------------x

AFFIDAVIT OF LOSS

I, ESTELITO F. JUMAPIT, JR, of legal age, Filipino and a resident

of Roman Diaz St., Calinan, Davao City, after having been duly sworn in
accordance with law, hereby depose and say that:

1. I am the person whose personal circumstances are described in

this affidavit;

2. Sometime in the month of February 2019, I left my vehicle one

KIA RIO LX MT with plate no. WPO961, at a car washing
establishment in Davao City to be cleaned and car washed. When I
went back to inspect my vehicle, I discovered that the Official
Receipt issued by the Land Transportation Office for the renewal
of registration of my vehicle for the year 2019 was already lost.

3. I exerted due diligence and persistent efforts in locating said

Official Receipt but to no avail and I now consider the same as
irretrievably lost.

4. I am executing this Affidavit to attest to the truth and veracity of

all the foregoing and to use the same for whatever legal purpose it
may serve best.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

24 day of June 2019 at Davao City, Philippines.
th

ESTELITO F. JUMAPIT, JR
Affiant

SUBSCRIBED AND SWORN to before me this 24 th day of June 2019

at Davao City, Philippines. Affiant, for purposes of identity, exhibited to me
his Driver’s License No. L02-07-005668.

Doc No. ___;

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