Republic of the Philippines)

Quezon City )SS.

AFFIDAVITOF LOSS

THE SOCIETY OF ST. PIUS X (PHILIPPINES) INC. (SSPX Philippines),

represented by Rev. Fr. Benoît Ludovic Wailliez, with office address at 2 Cannon Road
New Manila, Quezon City, under oath declare that:

1. The SSPX Philippines is the registered owner of the motor vehicle described
hereunder, to wit:

Model: 2003 Mitsubishi Adventure GLX DSL NT Upgraded

Prod. No. 438396
Color: Honza Silver
Chassis No. PAEVB5NJ13B000743
Engine No. 4D56A-N4477
IGN Key No. BA3783
Plate No. XHX390
OR No. 797782221
CR No. 21420450

2. As proof of ownership of the above-described vehicle, the SSPX Philippines was

issued by the Land Transportation Office (LTO) Certificate of Registration (CR);

3. While the said document was in our possession, it was misplaced, and all efforts to
find the same proved unrewarding, and can be concluded that it was lost and
beyond recovery;

4. The said document is not in the possession of any bank or lending companies by
reason of encumbrance/s or chattel mortgage;

5. The said document was not confiscated by government authorities in relation to

any investigation for violation of Republic Act No. 4136 or any laws, rules and
regulations;

6. I shall assume responsibility or liability if I will use this document for whatever
illicit transactions;

7. I am executing this sworn statement, as required in the sale of the aforementioned

vehicle, and to support the request for the issuance of a duplicate copy of the CR at
the LTO.
 IN WITNESS WHEREOF, I have hereunto affixed my signature this
_______________ in Quezon City.

REV. FR. BENOÎT LUDOVIC WAILLIEZ

Affiant

SUBSCRIBED AND SWORN to before me, in Quezon City, _________________,

the affiant exhibiting his Passport No. ____________ issued by ____________.

Doc.No. ______
Page No. ______
Book No. ______
Series of 2021