REPUBLIC OF THE PHILIPPINES
CITY OF MAKATI )
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 hand this ___________________ in Makati City, Metro Manila, Philippines .
____________________
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 2013.