Affidavit Of Loss - Or-cr.docx

REPUBLIC OF THE PHILIPPINES) QUEZON CITY ) S.S. x----------------------------x

AFFIDAVIT OF LOSS OR/CR I, ___________________, of legal age, Filipino, (single/married/widow) and a resident of _______________________________, after having been duly sworn to in accordance with law, depose and state THAT: 1. I am the registered owner of a motor vehicle which is particularly described as follows: Make & Type : ______________ Motor Number : ______________ Chassis Number : ____________ Plate Number : ______________ MV File No. : ________________ Year Model/Color : ___________ 2. As proof of ownership of the above-described vehicle I was issued by the Land Transportation Office, Official Receipt (OR) and Certificate of Registration (CR); 3. The said documents while in my possession were misplaced and could no longer be located in spite of diligent efforts to locate them; 4. Said documents were neither transferred to other persons/entity/financial institutions for any consideration nor encumbered to guarantee financial obligations with any financial institution; 5. Said documents were not confiscated by any government authorities for violation of R.A. 4136 and other related laws; 6. I shall assume responsibility or liability if in any event I will use these documents for whatever illicit transactions; 7. I am executing this affidavit to attest to the veracity of my statements and to support my request for duplicate copies of the lost MVRR/MVMRR/OR/CR with the Land Transportation Office (LTO).

IN WITNESS WHEREOF, I have hereunto set my this ___________________ in Quezon City, Metro Manila, Philippines.

hand

____________________ Affiant SSS ID No. _____________ SUBCRIBED AND SWORN TO before me this ___________________ in _________________, Philippines, affiant exhibiting to me his/her competent evidence of identity by way of __________________ issued at ______________ on __________________. Doc. No. _____; Page No. _____; Book No. _____; Series of 2018.