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Affidavit of Loss-Blank1

This document is an affidavit of loss for a license plate from an individual in the Philippines. It details that the individual owns a vehicle described by make, model, color, and plate number. It states that on a specific date, the front or rear license plate was lost despite efforts to find it. The individual is filing this affidavit to declare the loss and support an application for a new license plate.

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Samuel Corpuz
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46 views1 page

Affidavit of Loss-Blank1

This document is an affidavit of loss for a license plate from an individual in the Philippines. It details that the individual owns a vehicle described by make, model, color, and plate number. It states that on a specific date, the front or rear license plate was lost despite efforts to find it. The individual is filing this affidavit to declare the loss and support an application for a new license plate.

Uploaded by

Samuel Corpuz
Copyright
© © All Rights Reserved
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 )

PROVINCE OF NUEVA VIZCAYA )s.s.


MUNICIPALITY OF BAYOMBONG )

AFFIDAVIT OF LOSS
(License Plate )

I, ______________________________, of legal age, Filipino, and a resident of


______________________________, after having been duly sworn in
accordance with law, do hereby depose and state that:

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


describe as follows, to wit:

MAKE - - - - - - - - - ___________________
SERIES - - - - - - - - - ___________________
TYPE OF BODY - - - - - - - - - ___________________
MOTOR NO. - - - - - - - - - ___________________
CHASSIS NO. - - - - - - - - - ___________________
YEAR MODEL - - - - - - - - - ___________________
COLOR - - - - - - - - - ___________________
PLATE NO. - - - - - - - - - ___________________

2. On or about _____________________, the license plate (Front/Rear) of


the said motor vehicle was lost;

3. Despite diligent and utmost efforts in locating said license plate, the same
could not be found, thus I am now convinced that the same has already
been lost beyond recovery;

4. I am executing this Instrument to declare and attest to the veracity and


truthfulness of the foregoing and to support my application for the
issuance of new one in lieu of the one that was lost.

IN WITNESS WHEREOF, I have hereunto affixed my signature this


_______________________ hereat Bayombong, Nueva Vizcaya, Philippines.

______________________________
Affiant
ID No.

SUBSCRIBED AND SWORN TO before me this _______________________


hereat Bayombong, Nueva Vizcaya, Philippines.

Doc. No._____;
Page No._____;
Book No._____;
Series of 20___.

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