Republic of the Philippines]

City of D U M A G U E T E] S.S.

AFFIDAVIT OF LOSS

I, TOLOMEO M. ELTANAL, JR., of legal age, Filipino, married, and

a resident of West Balabag, Valencia, Negros Oriental, after being sworn in
accordance with law, do hereby depose and state, that:

1. I am the owner of a 2014 Suzuki FU150SCD2 with Plate No.

GD65062, and further described as follows:

CR No.: 177017912
OR No.: 1988344971 issued on 02/11/2021

2. I kept the original copy of the Certificate of Registration (CR) and

the Official Receipt (OR) as indicated above in a plastic envelope
and tucked it in the front compartment of the subject Multicab;

3. On March 20, 2023, I discovered that the original copy of the

Certificate of Registration and Official Receipt are missing;

4. Despite diligent search and efforts to locate said CR and OR, I could
not find them anymore such that I now believe that they are now
lost and beyond recovery;

5. As such, I am executing this Affidavit of Loss to attest to the

truth of the foregoing, to support my request for issuance of a new
CR and OR in lieu of the lost one, and for whatever legal purpose
it may serve best.

IN WITNESS WHEREOF, I have hereunto set my hand this ____day

of _________________ , at Dumaguete City, Philippines.

TOLOMEO M. ELTANAL, JR.

Affiant
PRC ID No. 0051425

SUBSCRIBED AND SWORN to before me this ____ day

of___________________, the affiant exhibiting his competent evidence of
identify as above indicated. Known to and to me known to be the person
who executed the foregoing instrument and he acknowledged to me that
the same is his free act and deed.

1
 WITNESS MY HAND AND SEAL on the date first above-written.

Doc. No. ____.

Page No. ____.
Book No. ____.
Series of 2023.