Republic of the Philippines

Province of Sorsogon S.S.

Sorsogon City

AFFIDAVIT OF LOSS
I, JOHN PAULO B. DEALCA, Filipino, of legal age, single, with residence
and postal address at Gate 3, SPPVS Barangay Bibincahan, Sorsogon City under
oath depose and say:

1. That last January 29, 2021 at around 7:00 in the evening I was driving a
Honda car with Plate No. WAJ 329, from Legazpi City going to
Sorsogon City.

2. That as I move toward Barangay Salvacion, Sorsogon City, I decided to

stopped momentarily and as I alighted from the car, I noticed that the
Vehicle Registration Plate of the vehicle was already detached and
missing.

3. That despite diligent effort to look for the missing Vehicle Registration
Plate it can no longer be located such that I consider it lost and beyond
recovery.

4. That I am executing this affidavit to attest to the truth of the foregoing

statement and for whatever legal purpose this may serve;

IN WITNESS WHEREOF, I have hereunto set my hand this ____

day of February 2021 at Sorsogon City.

JOHN PAULO B. DEALCA

Affiant
DL No. E05-13-001140

SUBSCRIBED and SWORN to before me this ____ day of February 2021

at Sorsogon City, affiant exhibited his Government issued ID indicated below his
signature with photograph in his likeness.

Notary Public

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2021;