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Affidavit of Loss

Affidavit of Loss of Car Registration

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12 views1 page

Affidavit of Loss

Affidavit of Loss of Car Registration

Uploaded by

Collagen Gundam

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AFFIDAVIT OF LOSS

I, Crescenciana N. Montayre, of legal age, Filipino citizen, and resident of 37 F. Cabahug St.,
Mabolo, Cebu City, Philippines, after being duly sworn in accordance with law, hereby depose
and state under oath:

1. I am the registered owner of a motor vehicle which is particularly described as follows:

● Make & Type : Utility Vehicle Pick Up (Multicab)

● Engine Number : F5A-2168930
● Chassis Number : DB71T-120137
● Plate Number : GRL 848
● MV File No. : 0751-00000000937
● Year Model: 2002
● Color : White

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.

IN WITNESS WHEREOF, I have hereunto set my hand this 30th day of October, 2024, in Cebu
City, Philippines.

________________________
Crescenciana N. Montayre

SUBSCRIBED AND SWORN to before me this ___ th of November, 2024, in Cebu City,
Philippines, affiant exhibiting competent evidence of identity through Senior Citizen ID with ID
______ , issued on ___________ .

WITNESS MY HAND AND SEAL.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2024

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Affidavit of Loss

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Affidavit of Loss

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AFFIDAVIT OF LOSS

1. I am the registered owner of a motor vehicle which is particularly described as follows:

● Make & Type : Utility Vehicle Pick Up (Multicab)

2. As proof of ownership of the above-described vehicle I was issued by the Land

7. I am executing this affidavit to attest to the veracity of my statements and to support my

WITNESS MY HAND AND SEAL.

Doc. No. _____;

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