AFFIDAVIT
OF LOSS
REPUBLIC
OF THE PHILIPPINES)
_____________________________
) S.S.
I,
(Name of Affiant)., Filipino, of legal age, residing at (Address of
Affiant), after having been sworn in accordance with law hereby depose and
state:
That
I am the true and lawful owner of a certain
motor vehicle which is more particularly described as follows:
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MAKE
:
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MOTOR
NO.
:
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SERIES
:
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SERIAL/CHASSIS
NO. :
|
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TYPE
OF BODY :
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PLATE
NO.
:
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YEAR
MODEL :
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FILE
NO.
:
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That sometime in June of this year, I was looking for the original Certificate
of Registration of my car but to my surprise, said Owner’s original Copy could
not found;
That I took pains to look for said Certificate of Registration, but
to no avail;
That I am executing this affidavit to attest to the truth of the foregoing and
to request from the Land Transportation Office of Angeles City, a
copy of said Certificate of Registration.
IN
WITNESS WHEREOF, I have hereunto set my hand this _____ day of _______________.
20___ at _________________________.
(Name
Over Signature of
Affiant)
SUBSCRIBED AND SWORN to before me, this ____ day of ______________, 20___ in
___________________ City, with affiant exhibiting his CTC No. _______________ ,
Issued
on ______________________ at _________________________.
NOTARY PUBLIC
Until December 31, 200___
Doc.
No. : ________;
Page
No. : ________;
Book
No. : ________;
Series
of 20___.