REPUBLIC OF THE PHILIPPINES)

QUEZON CITY ) S.S

AFFIDAVIT OF LOSS

That I, GEORGE HUERTAS MAURICIO, of legal age, Filipino and a resident of 2095
SANTIAGO ST GEN T DE LEON VALENZUELA CITY, after being sworn to in
accordance with law, hereby depose and say, THAT:

1. I am authorized driver of the motor vehicle described as follows:

MV FILE NO: 1301-00000205910

PLATE NO: AAX 7574
ENGINE NO: 4D34N83562
CHASSIS NO: JL6JAB6H2EK008923
MAKE: MITSUBISHI
SERIES: CANTER
BODY TYPE: TRUCK
FUEL/YEAR MODEL: DIESEL/2014

2. On September 26, 2023, at around 8:00 A.M, I drove the said vehicle to BULACAN to
deliver the IPM TUBE, at around 8:00 P.M, September 26, 2023, we returned to our
office at 476 QUEZON AVENUE CORNER EDSA, SOUTH TRIANGLE,
QUEZON CITY, and discovering that the FRONT PLATE NO. AAX 7574, of the said
vehicle was missing;

3. I lost no time in diligently trying to locate the said FRONT PLATE NO. AAX 7574 but
all efforts exerted proved futile and no to avail, and that the same is considered lost and
beyond recovery;

4. The said lost plate was never lent to another person or entity nor confiscated by any other
law enforcement agency;

5. I am executing this Affidavit to attest to the truth of the foregoing statements and for
whatever purpose it may serve in my behalf.

FURTHER SAYETH NAUGHT.

GEORGE HUERTAS MAURICIO

Affiant

SUBSCRIBED and SWORN to before me this September 27, 2023 at Quezon City, affiant
exhibited to me his/her, community tax certificate.

Doc. No.______
Book No._____
Page No._____
Series of 2023