REPUBLIC OF THE PHILIPPINES)

___________________ ) S.s.
___________________ )
x- - - - - - - - - - - - - - - - - - - - - - - -x

AFFIDAVIT OF LOSS
I, _______________, Filipino, of legal age, married and a resident of
__________________________, after having been sworn in accordance with law
hereby deposes and states:

1. That I am the very same person executing this affidavit;

2. That I am the registered owner of a motor vehicle particularly described as

follows:

Make/Type : ______________
MV File No. : ______________
Plate Number : ______________
Engine No. : ______________
Chassis No. : ______________
Year Model : ______________

3. That I kept the original copy of Certificate of Registration of the abovementioned

vehicle inside my wallet but when I need the same and checked it, I can no longer
find it;
4. That despite diligent search and efforts to locate the Certification of Registration
in all possible locations, all attempts turned futile that I still could not find the
same therefore considered lost beyond recovery;
5. As such, I am executing this Affidavit of Loss to attest to the truth of the
foregoing and for whatever legal purposes it may serve.

IN WITNESS WHEREOF, I hereby affix my signature this ____ day of _________

in _________________a, Philippines.

___________________
Affiant
ID type and no._______________
Valid until: ______________

SUBSCRIBED AND SWORN to before me this ___ day of _____________,

in ______________, with affiant exhibited to me their proof of identity as stated
above.

Doc. No.______;
Page No.______;
Book No.______;
Series of 2024.