PHILIPPINES ) Municipality of Sergio Osmeňa Sr., ) SS.
AFFIDAVIT OF LOSS
I, LORENZO GUMONOD INTONG, Filipino, of legal age, married, and a resident
of Biayon, Sergio Osmeňa, Zamboanga del Norte under oath hereby depose and state:
1. THAT I am a registered owner/holder of a Certificate of Registration of my KIA
vehicle with plate number JAJ 3599 issued by the Honorable Land Transportation Office of Sindangan which is valid until September 2021; 2. THAT sometimes on January 6, 2021 somewhere in the Sergio Osmeňa, Zamboanga del Norte, I discovered that I lost the original copy of the said Certificate of Registration of my vehicle; 3. THAT I exerted diligent efforts to locate the said Certificate of Registration of my vehicle but to no avail and I therefore considered the same as lost and can no longer be found; 4. THAT I am executing this Affidavit to attest to the truth of the foregoing facts, for the re-issuance of a new Certificate of Registration in lieu of the lost one and for whatever legal purpose it may serve.
IN WITNESS WHEREOF, I hereunto affix my signature this ______________ at
Sergio Osmeňa, Zamboanga del Norte, Philippines.
LORENZO GUMONOD INTONG
Affiant VIN:7214-0004B-L2860LGI10000
SUBSCRIBED AND SWORN to before me this ________________ at Sergio
Osmeňa, Zamboanga del Norte, affiant exhibited to me his valid proof of Identity as above-stated.
EARL RUSSELL S. PAULICAN
Notary Public Until December 31, 2021 Roll No. 75530 PTR No. 2185126, 01/04/2021, Dipolog City TIN # 472-022-138 Notarial Commission No. SN: ZDN-DPL-042-2020
Doc No. ________;
Page No. _______ ; Book No. _______; Series of 2021.