Republic of the Philippines)

Davao City ) S.S

AFFIDAVIT OF LOSS

I, Ruben T. Odod, Jr., of legal age, married, Filipino, and a resident of Panacan, Davao
City, after having been sworn to in accordance with law hereby depose and state that:

1. I am the lawful possessor of a motorcycle more particularly described as

follows:

Make/Type: Honda MC
Engine No.: KPYV0E024277
Chassis No.: KPYV0024282
File No.: 1101-00001120643
Plate No.: 707 LXL

2. I purchased the said motorcycle from L&L Furniture & Appliance Showroom
(L&L Furniture, for brevity) on an installment basis as evidenced by a Certificate
of Sale from L&L Furniture herein attached as Annex A;

3. The said motorcycle is still registered under the name of one John Mel M.
Hormigos;

4. On or about February 18, 2023, I have recently discovered that the above-
stated plate number was irretrievably lost and can no longer be found despite
diligent search and efforts to locate the same proved futile;

5. The said plate was not confiscated by any government authorities for violation
of RA 4136;

6. As such, I am executing this affidavit to attest to the truth of the foregoing facts
and to support the application for the issuance of a new license plate in place of
the one that was lost.

IN WITNESS WHEREOF, I have hereunto set my hand this ___________________ at

Davao City, Philippines.

Ruben T. Odod, Jr.

Affiant

SUBSCRIBED AND SWORN TO before me this ________________ at Davao City,

Philippines, affiant exhibited to me his Driver’s License bearing the number L01-20-004389
as his competent evidence of identity.

Doc. No.:______;
Page No.:______;
Book No.:______;
Series of 2023.