Republic of the Philippines)

City of Sorsogon )S.c.

AFFIDAVIT OF LOSS

I, WILFREDO O. DETERA, of legal age, Filipino, with residence at Rosville

Subd., Bibincahan, Sorsogon City, after having been duly sworn in accordance with law,
hereby depose and say:

1. That I am the registered owner of motor vehicle specifically described as follows:

MAKE : Yamaha Sniper 135 motorcycle without sidecar

PLATE NO : _________________
Engine no. : _________________
Chassis no. : _________________

2. That said vehicle was issued the Plate no __________ by the Land
Transportation Office of Sorsogon City;

3. That said vehicle was also issued an Official Receipt (OR) and Certificate of
Registration (CR)
4. unfortunately, the said plate was stolen from the motor vehicle sometime in 2020
at the Rompeolas, Sorsogon City, and it was only the next day, that I noticed that
the plate number of the vehicle was gone from its place;

5. Unfortunately, the OR and CR of the vehicle were also lost sometime in 2019 as
it could no longer be found in any of our belongings despite diligent

6. That said Plate number was never lent to another person or entity nor
confiscated by any other law enforcement agency;

7. That despite diligent efforts to locate the OR, and CR, but these couldn’t be
found, hence I am considering these lost forever;

8. That due efforts has been made in order to retrieve said Plate number but to no
avail, thus, I am considering it lost forever;

9. That I bind myself to surrender said Plate to the Land Transportation Office that
issued the same in the event that said plate is recovered;

10. That I am executing this affidavit to attest to the foregoing facts and for legal
purpose and intent this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ____ day of

___________ at Sorsogon City.

WILFREDO O. DETERA

SUBSCRIBED AND SWORN to before me this _______________ at Sorsogon City,

affiant having ascertained by me through his LTO Driver’s License ID no. E05—05-029007.
Doc no.
Page no
Book no.
Series of 2020