Republic of the Philippines )

City of Dipolog                    ) S.S

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

AFFIDAVIT OF LOSS

I, NANCY P. DIONALDO, Filipino, of legal age and a resident of Laoy, Olingan,

Dipolog City, after having duly sworn in accordance with law, do hereby depose and state
that:

1. That I am the registered owner of a certain TRICYCLE vehicle, which is more

particularly described as follows:

Type of Body: Tricycle MOTOR NO. : 34C4004744

Year Model: SERIAL/CHASSIS NO. : 34C4011575
C.R No.: 149117835 PLATE NO. : JZ 1806
Franchise DPLG No.2020-1049

2. That as a registered owner, I was issued a Franchise Registered Sticker for my

franchise issued last June 2019 by City Hall of Dipolog;

3. That the registered franchise sticker was removed by an unknown person while
parked outside of my residence;

4. That despite diligent search and efforts to locate the registered franchise sticker,
I could no longer find the same such that I now believe that it is now lost;

5. As such, I am executing this affidavit of loss to attest to the truth of the

foregoing and to support my application for the issuance of new franchise
registered sticker in lieu of the one that was lost.

  IN WITNESS WHEREOF, I have hereunto affixed my signature this ______________at

Dipolog City, Philippines.
 

NANCY P. DIONALDO
Affiant

SUBSCRIBE AND SWORN to before me this ____________at Dipolog City,

Philippines, with affiant exhibiting to me her Valid Id No.____________________.

Doc. No.____
Page No. ____
Book No._____
Series of 2020
Republic of the Philippines )
City of Dipolog                    ) S.S
x------------------------------------x 

AFFIDAVIT OF LOSS

I, FREDERICK S. CALOG, of legal age, Filipino, married and a resident of

Barangay Alvinda, Mutia, Zamboanga del Norte, after having duly sworn in accordance with
law, do hereby depose and state that:

1. That I am a holder of an Official Receipt from a purchase of a chainsaw in

Oroquieta City in the year 2017 which is more particularly described as follows:
BRAND SERIAL MACHINE NO.

ZERO70 STEEL S178200084

2. That the said document while in my possession was misplaced and could no
longer ne located inspite of exerting efforts of locating them;

3. That I am executing this affidavit to attest the truth of the foregoing and for
whatever legal purpose it may serve.

AFFIANT FURTHER SAYETH NAUGHT.

  IN WITNESS WHEREOF, we have hereunto affixed our hands this____ day of

_______________ at ________________.
 

FREDERICK S. CALOG
Affiant
Philhealth ID 16-050166521-2

SUBSCRIBE AND SWORN TO before me this August 31, 2018 at Dipolog City.

Doc. No.___
Page No.___
Book No.___
Series of 2018.