Republic of the Philippines))

La Trinidad, Benguet) s.s

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AFFIDAVIT OF LOSS OF MOTOR VEHICLE PLATE NUMBER

I, Carol L. Donato, of legal age, married, Filipino citizen and a resident of Gabriela
Silang, Baguio City, Philippines, after having duly sworn to in accordance with law, do hereby
and depose and state THAT:

1. I am the owner and possessor of a certain motor vehicle with a Certificate of

Registration (CR) No.: ______________ dated June 7, 2016 and Official Receipt No.
1530987452 by the Land Transportation Office (LTO). Said motor vehicle is
particularly described as follows, to wit:

File No: 1356-00000067999 Plate No.: NXI 365

Make: Mitsubishi Series: Montero Sport SE
Type: Wagon Motor No.: 4M41UCAR8853
Fuel: Diesel Serial/Chassis No.: KE50-907336

Model: 2009

2. Sometime in the morning on October 29, 2019, I used/drove my afore-cited vehicle

from our house at Gabriela Silang, Baguio City going towards La Trinidad, Benguet
particularly somewhere at Pines Park, Balili, La Trinidad, Benguet where I conduct
my business. At that time, the Plate Number NXI 365 of my vehicle was still intact
with the front bumper of said vehicle. Upon arriving thereat, when I parked my
vehicle, it was then and there that I noticed the Plate Number NXI 365 was no longer
attached to the front bumper. I tried to search immediately in the premises to locate
for the same but it was nowhere to be found. I also went to the Office of the Barangay
Chairman of Balili, La Trinidad, Benguet to inquire if confiscated. Nonetheless, the
said office replied that they do not have the plate number of my vehicle.

3. I have exerted due diligence to recover said vehicle Plate No. NXI 365 but such effort
turned futile since the same was never found or cannot be located. I am now of the
honest belief that said plate number is already lost and beyond recovery;

4. The said Plate Number NXI 365 was not confiscated by any Government authority or
law enforcement agency as a result of any violation of law nor delivered to any
person or entity for the satisfaction of any civil obligation.

5. I am executing this Affidavit to attest to the truth of the foregoing facts and for all
legal intents and purposes this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 30th day of October 2019,
at La Trinidad, Benguet, Philippines.

Carol L. Donato
Affiant
Philippine Passport No. P5672165A
Valid until Jan. 17, 2028

SUBSCRIBED AND SWORN to before me a Notary Public for and in La Trinidad,

Benguet, Philippines this October 30, 2019, by the above Affiant, personally known to me by
competent evidence of her identity to be the same person who personally signed before me the
foregoing Affidavit.
ATTY. CYRUS C. CALAYA
Doc. No. 311; Notary Public until Dec. 31, 2019
Page No. 63; PTR No. BGT 5358129, Jan. 4, 2019
Book No. VI; IBP Lifetime No. 08051, at Pasig City
Series of 2019. Roll No. 52590, May 12, 2006; Manila
S & B Bldg., FA 224, Km. 4, La Trinidad, Benguet