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Affidavit of Loss or

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18 views1 page

Affidavit of Loss or

Uploaded by

Phe Pacamarra

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AFFIDAVIT OF LOSS OR/CR

I, GODOFREDO F. ANIFELIPE, of legal age, Filipino, Married, and a resident of

156 Zone 6 Dinaga Canaman, Camarines Sur , 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.

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Affidavit of Loss or

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Affidavit of Loss or

Uploaded by

AFFIDAVIT OF LOSS OR/CR

I, GODOFREDO F. ANIFELIPE, of legal age, Filipino, Married, and a resident of

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

Make & Type : ______________

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

4. Said documents were neither transferred to other persons/entity/financial

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

IN WITNESS WHEREOF, I have hereunto set my hand

SUBCRIBED AND SWORN TO before me this ___________________ in

Doc. No. _____;

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