REPUBLIC OF THE PHILIPPINES}

IN THE CITY OF DAVAO }s.s

x``````````````````````````x

AFFIDAVIT OF LOSS

I, ERNESTO M. LU, Filipino, of legal age, and a resident of Corner

Suraya Homes, Cabantian, Davao City, under oath depose and state that::

1. I am a holder of Land Transportation Office (LTO) official receipt

bearing No.1678423913 and issued July 16, 2019;

2. On June 05, 2020, the above-mentioned receipt, for one reason or

another, was lost in my possession;

3. despite the diligent efforts exerted, the same could no longer be

found;

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

facts, to inform the authorities concerned, and for all legal intents
and purposes.

IN WITNESS WHEREOF, I have affixed here my signature this 21 st

day of July 2020 at Davao City, Philippines.

ERNESTO M. LU
Affiant

SUBSCRIBED AND SWORN to before me this 21st day of July 2020

at Davao City, Philippines, affiant exhibiting to me his PHIC ID No. 16-
025239506-4 at Davao City, Philippines.

Doc.No. ______;
Page No. ______;
Book No.______;
Series of 2020;