REPUBLIC OF THE PHILIPPINES)

CALOOCAN CITY ) S.S.

JOINT AFFIDAVIT OF LOSS

We, ______ and ________, Filipinos, both of legal age, and with residence
address at , after being duly sworn to in accordance with law, hereby depose and
state

1. That I was issued a Certificate of Registration with CR No. and an

Official Receipt with OR No. for the motorcycle with side car that we
purchased/acquired as registered owners with the following details (“OR/CR”):

MV File No.:
Engine No.:
Chassis No.:
Make:
Body Type:
Year Model:

2. That on June 15, 2021, the said OR/CR got lost by accidentally
throwing out some stuff, documents and other materials in the house, including
the said OR/CR, when we were renovating our house in Deparo, Caloocan City;

3. That despite diligent search and efforts to locate the OR/CR, we

could not find the same such that we now have reasons to believe that it is now
lost and cannot be recovered;

4. Our vehicle’s OR/CR has not been confiscated by any government

agency;

5. As such, I am executing this Affidavit of Loss to attest to the truth of

the foregoing and for whatever legal purpose this may serve.

IN WITNESS WHEREOF, we have hereunto set our hands this ___ day of
___________, 2021, in Caloocan City.

NARCISA MALAPIT MUYARGAS VICTOR VILLAMIL MUYARGAS

Affiant Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, a Notary Public for and

in ______________, this __ day of _________, 2021, affiant personally came and
appeared with their identification cards as their respective competent proof of
identity, bearing their photographs and signatures, and known to me as the same
persons who personally signed the foregoing instrument before me and avowed
under penalty of law to the whole truth of the contents of the said instrument.

Doc. No. __;

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