AFFIDAVIT OF LOST OFFICIAL RECEIPT

I, JERIC ESPEJON, of legal age, married and resident of TOGORON MONREAL,

MASBATE, after having been duly sworn to in accordance with law, hereby depose and state
THAT:

1. I am the owner, holder and in possession of OFFICIAL RECEIPT(OR)

2. The said OFFICIAL RECEIPT(OR) 352378 while in my possession were

misplaced by the undersigned last April 2022 and its whereabouts cannot anymore
ascertained despite due and diligent search made and undertaken;

3. The said OFFICIAL RECEIPT(OR)were not confiscated by any government

authorities in any violation of RA4136 and other related laws of the Philippines;

4. I shall assume responsible and liable if in any event I use the said OFFICIAL
RECEIPT(OR)for whatever illicit transactions;

5. I am executing this affidavit to attest to the truth of the foregoing facts and statement
and to support the same in my request for a replacement OR in lieu of the lost one.

IN TRUTH WHEREOF, I have hereunto signed this 19 th day August at Masbate City,
Philippines.

JERIC ESPEJON
Affiant

SUBSCRIBED AMD SWORN to before this 19th day May at Masbate City, Philippines.
Affiant exhibited to me his/her Identification indicated below his/her name and signature as
competent evidence of his/her identity.
Republic of the Philippines )
Province of Masbate ) S.S.
City of Masbate )
x --------------------------------- x

AFFIDAVIT OF PURPOSE

I, MENCHU N. ABENIR, of legal age, Filipino, single/married and a resident of

Buenavista Uson, Masbate, under oath depose and say, that:

1. That I am the registered owner of a Motor vehicle described as follows:

Make : YAMAHA
Color : BLACK
Motor No. : 34C2023203
Chassis No. : 34C2022939
C.R. No. :

2. That the motor vehicle is registered at LTO, Region 5 New Registration Unit;

3. That I attached a sidecar to my motor vehicle for Private use only;

4. That I execute this affidavit so I could register my motor vehicle at LTO, Masbate
City.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 13 th day of

November, 2019 at Masbate City, Philippines.

MENCHU N. ABENIR
Affiant

SUBSCRIBED AND SWORN to before me this 13th day of November, 2019 at

Masbate City, Philippines.