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    Affidavit of Loss OR/CR of Motor Vehicle

    CITY OF MAKATI            ) S.S.


     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 hand this ___________________ in Makati City, Metro ManilaPhilippines.

    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 2013.

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