REPUBLIC OF THE PHILIPPINES

( CITY OF MAKATI ) S.S.

AFFIDAVIT OF LOSS

I, FLORO APCINAR LLAGUNO, of legal age, single, Filipino, and a resident of

WELLINGTON RESIDENCE BRGY. TRES CRUSES TANZA CAVITE, after having been sworn to
in accordance with law hereby depose and say that:

1. I am a holder of LTO CERTIFICATE OF REGISTRATION duly connected on a vehicle

to wit.

MAKE & TYPE : SYM EURO

PLATE NO. : BD87911
MOTOR NO. : 0201-00000297474
MODEL : MOTORCYCLE WITHOUT SIDE CAR

2. That sometime on September 02, 2023, while traveling on Remulla Drive going to
my Vicinity in wellington residence, I accidentally lost the aforementioned
documents together with my small wallet.

3. That immediately after discovery of such loss or incident, I have exerted diligent
effort to recover the aforesaid document and it was considered lost for all intents
and purposes.

4. I execute this affidavit to attest to the truthfulness of the foregoing information,

and to secure the replacement of the said document as it was mandatorily needed
on my day to day living and for whatever legal purpose it may serve.

FURTHER AFFIANT SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 09TH day of

September 2023 in MAKATI City, Metro Manila, Philippines

FLORO APCINAR LLAGUNO

Affiant

SUBSCRIBED AND SWORN to before me this day of September 2023 in _______

City, Metro Manila Philippines. Affiant exhibited to me his competent evidence of identity
as ______________________.

Doc No. ______ NOTARY PUBLIC

Page No. _____
Book No. _____
Series of 2023