Republic of the Philippines)
______________________ ) Sc.
AFFIDAVIT OF
LOSS
LOSS
I,
______________________, Filipino, of legal
age, married, and with residence and postal address at ________________________________________________________________,
after having been duly sworn to in accordance with law, hereby depose and state
that:
______________________, Filipino, of legal
age, married, and with residence and postal address at ________________________________________________________________,
after having been duly sworn to in accordance with law, hereby depose and state
that:
1.
I have been trying to look for the
original Certificate of Registration of my car with the following details:
I have been trying to look for the
original Certificate of Registration of my car with the following details:
|
MAKE
: |
MOTOR
NO. : |
|
SERIES
: |
SERIAL/CHASSIS NO.
: |
|
TYPE OF BODY :
|
PLATE NO.
: |
|
YEAR
MODEL : |
FILE NO.
: |
|
|
C.R.
NO. : |
2.
Diligent efforts to locate the said document
were exerted but it proved futile; and
Diligent efforts to locate the said document
were exerted but it proved futile; and
3.
I am executing this affidavit to attest
to the truthfulness of the foregoing facts and for the purposes of declaring it
loss and for whatever legal purpose it may serve.
I am executing this affidavit to attest
to the truthfulness of the foregoing facts and for the purposes of declaring it
loss and for whatever legal purpose it may serve.
IN
WITNESS WHEREOF, I have hereunto set my hand
this _____ day of ____________________ at __________________,
Philippines.
WITNESS WHEREOF, I have hereunto set my hand
this _____ day of ____________________ at __________________,
Philippines.
AFFIANT
FURTHER SAYETH NAUGHT.
FURTHER SAYETH NAUGHT.
______________
Affiant
JURAT
SUBSCRIBED
AND SWORN to before me this _____ day
of ____________________________ affiant personally appeared
and exhibited to me his Government-issued Identification Card No. ________________________,
issued on _____________________ at City of Makati.
AND SWORN to before me this _____ day
of ____________________________ affiant personally appeared
and exhibited to me his Government-issued Identification Card No. ________________________,
issued on _____________________ at City of Makati.
NOTARY
PUBLIC
PUBLIC
Doc. No.: _____;
Page No.: _____;
Book No.: _____;
Series of 2019.
