Republic of the Philippines)

City of General Santos ) S.S. 

AFFIDAVIT OF LOSS

I, DARWIN E. FEROLINO, of legal age, Filipino, married, and a resident of

Animas Subd., Purok Yellowbell, Brgy. Sta. Cruz, Koronadal City, South Cotabato,
after being duly sworn to in accordance with law, hereby depose and state that:

1. I am the owner and holder of an LTO Certificate of Registration (CR)

containing the following details:
CR No : 34553940
Reg. Date : 08/23/2019
Unit : Toyota Hilux 2.4L 4x2
MV File No. : 1324-00000795966
Plate No. : NEF1337
Owner’s Name : Darwin Ergino Ferolino

2. I have recently discovered that said LTO CR got lost, and that despite
diligent efforts exerted, I could no longer locate, find or recover the same;

3. Said LTO CR has not been confiscated by any officer of the law or the
issuing office or agency due to the violation of any law, statute, order, rule or
regulation;

4. In the event that the lost item should hereafter be found or located, I
undertake to forward or surrender the same to the Land Transportation
Office for appropriate disposal;

5. I am executing this Affidavit to attest to the truth of the foregoing statements

and for the purpose of processing the renewal of my registration with
the LTO.

AFFIANT FURTHER SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto set my hand this July 6, 2022 at

General Santos City, Philippines.

DARWIN E. FEROLINO
Affiant
ID No. D014-0012

SUBSCRIBED AND SWORN to before me this July 6, 2022 in General Santos

City, affiant exhibited to me his Competent Evidence of Identity above.

Doc. No. ______;

Page No. ______;
Book No. _____;
Series of 2022.