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Affdavit of Loss

Sample affidavit of loss

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Ghem Hope

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0% found this document useful (0 votes)

20 views1 page

Affdavit of Loss

Sample affidavit of loss

Uploaded by

Ghem Hope

We take content rights seriously. If you suspect this is your content, claim it here.

Available Formats

Download as DOCX, PDF, TXT or read online on Scribd

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REPUBLIC OF THE PHILIPPINES)

CITY OF ) S.S

AFFIDAVIT OF LOSS

I, _______________, of legal age, Filipino, married and with residence

at_____________________________________ under oath, depose and state that:

1. I am the registered owner of one (1) unit, _____________, described as follows:

Make :
Type :
Model :
Engine No :
Chassis No. :
M/V File No. :

Plate No. :
2. As proof of ownership of the above described Motor Vehicle, I was issued a
Certificate of Registration (CR) No. _________by the ______________City
District Office of the Land Transportation Office (LTO).
3. Said CR were safely kept inside my bag; however on August 22, 2022 my bag
was lost in transit when I traveled to _______________
4. I have exerted all efforts to locate my bag, but despite all the effort, I could
not find the same.
5. The original copies of CR were not assigned, mortgage, encumbered and/or
sold to any third person. The same was lost.
6. I execute this Affidavit to attest to the truthfulness foregoing facts and to
request for duplicate copies of my lost CR, and for whatever legal purpose it
may serve.

IN WITNESS WHEREOF, I have hereunto set my hands this ____th day of

November 2024 in ______________________City, Philippines.

______________________________
Affiant

SUBSCRIBED AND SWORN to before me this _____ day of November 2024 in

__________________City, Philippines. Affiant exhibited to me his competent evidence
of identity as ________________________

Notary Public

Doc. No.__________;
Page No. __________;
Book No.__________;
Series of 2024

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Affdavit of Loss

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Affdavit of Loss

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REPUBLIC OF THE PHILIPPINES)

I, _______________, of legal age, Filipino, married and with residence

1. I am the registered owner of one (1) unit, _____________, described as follows:

IN WITNESS WHEREOF, I have hereunto set my hands this ____th day of

SUBSCRIBED AND SWORN to before me this _____ day of November 2024 in

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