Republic of The Philippines) MUNICIPALITY OF - ) S.S. Province Of) X - X Affidavit of Loss Or/Cr
The document is an affidavit of loss filed by Juan B. Dela Cruz regarding his lost vehicle registration documents. In the affidavit, Dela Cruz states that he is the registered owner of a described motor vehicle but that the official receipt and certificate of registration issued by the Land Transportation Office were misplaced despite efforts to locate them. He further attests that the documents were not transferred, encumbered, or confiscated by authorities. Dela Cruz executes the affidavit to support his request for duplicate registration documents from the LTO.
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Republic of The Philippines) MUNICIPALITY OF - ) S.S. Province Of) X - X Affidavit of Loss Or/Cr
The document is an affidavit of loss filed by Juan B. Dela Cruz regarding his lost vehicle registration documents. In the affidavit, Dela Cruz states that he is the registered owner of a described motor vehicle but that the official receipt and certificate of registration issued by the Land Transportation Office were misplaced despite efforts to locate them. He further attests that the documents were not transferred, encumbered, or confiscated by authorities. Dela Cruz executes the affidavit to support his request for duplicate registration documents from the LTO.
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REPUBLIC OF THE PHILIPPINES)
MUNICIPALITY OF___________ ) S.S.
PROVINCE OF ) x----------------------------x
AFFIDAVIT OF LOSS OR/CR
I, Juan B. Dela Cruz, of legal age, Filipino, married, 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 6th day
of August 2018 in, Philippines. ____________________ Affiant SSS ID No. _____________
SUBCRIBED AND SWORN TO before me this day of in, Philippines,
affiant exhibiting to me her competent evidence of identity by way of __________________ issued at ______________ on __________________.