(Affidavit of Loss CR of Motor Vehicle)
Republic of the Philippines)
Province of________________) S.S.
City/Municipality of_____________)
x---------x
AFFIDAVIT OF LOSS
I, ________________, Filipino, of legal age, single/married, with postal
address at ________________________________________Philippines;
after being duly sworn in accordance with law, hereby depose and state:
That I am the registered owner of a certain motor vehicle, which is more
particularly described as follows:
Make: ______________
Model: ______________
Type of Body: ______________
Motor No.: ______________
Chassis No.: ______________
Yr. Model: ______________
Color: ______________
Plate No.: ______________
That, as a registered owner, I was issued a Certificate of Registration (C.R.)
for my registration of the above-mentioned motor vehicle by the Land
Transportation Office of _______________ City, Philippines;
That, I could no longer find the said Certificate of Registration of the said
motor vehicle;
That, despite diligent search and efforts to locate the said document, I could
no longer find the same, such that I believe it is now lost beyond recovery.
As such, I am executing this Affidavit of Loss to attest to the truth of the
foregoing and to support my application for the issuance of a new
Certificate of Registration, in lieu of the one that was lost.
IN WITNESS WHEREOF, I have hereunto set my hand this _____________,
in the City of ___________, Philippines.
(JURAT)
