REPUBLIC OF THE 

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.