Scribd
Upload
93 views1 page

Affidavit of Loss

1) Aladine Guzman Goddi filed an Affidavit of Loss stating that the rear license plate of the vehicle he was driving fell off while traveling from Binga to Buyagan in Benguet, Philippines. 2) Despite searching diligently, the lost rear plate could not be found. Goddi declared the plate lost beyond recovery. 3) Goddi affirmed that the plate had not been confiscated by authorities and was signing the affidavit to attest to the truth of the loss and accept any administrative penalties imposed as a result.

Uploaded by

Reyjohn Lodias
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
93 views1 page

Affidavit of Loss

1) Aladine Guzman Goddi filed an Affidavit of Loss stating that the rear license plate of the vehicle he was driving fell off while traveling from Binga to Buyagan in Benguet, Philippines. 2) Despite searching diligently, the lost rear plate could not be found. Goddi declared the plate lost beyond recovery. 3) Goddi affirmed that the plate had not been confiscated by authorities and was signing the affidavit to attest to the truth of the loss and accept any administrative penalties imposed as a result.

Uploaded by

Reyjohn Lodias
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
You are on page 1/ 1

REPUBLIC OF THE PHILIPPINES )

PROVINCE OF BENGUET ) s.s.


MUNICIPALITY OF LA TRINIDAD)
x-----------------------x

AFFIDAVIT OF LOSS

I, ALADINE GUZMAN GODDI, Filipino, of legal age, single and a resident of ac 139-
c Eastern Buyagan, La Trinidad, Benguet, Philippines, after being duly sworn in accordance with
law, depose and state:

1. That I am the driver of that motor vehicle, owned by Gerald Tacay, particularly described
as follows: MAKE: Mits; Series: Delica; TYPE OF BODY: van; YEAR MODEL:1991;
PLATE NO.: RBL 732;
2. That on April 02, 2020 I drove the said motor vehicle from Binga, Itogon, Benguet to
Buyagan, La Trinidad, Benguet for a certain transaction. When I reached Buyagan, I was
shocked to find out that the rear plate number of the motor vehicle was missing. It might
have fallen off the vehicle on the way as only the bolt holding it remained attached to the
vehicle;
3. That despite diligent search and effortsthe rear plate number of the above-mentioned
motor vehicle could not be found. I am therefore declaring it lost beyond recovery;
4. That said License Plate of my vehicle has not been confiscated by the LTO, Police, or
other Traffic Enforcers for any traffic violation neither was it surrendered for any
obligation whatsoever;
5. If the DOTC thru the LTO/LTFRB, after inquiry, has found me responsible for the
unauthorized use of the herein reported lost plate number, I hereby signify my conformity
to be meted the administrative fines and penalties due and imposed thereon, including the
grounding of the unit covered by the plate number issued therefore, with waiver and
desistance on my part for any claim or action by reason of the aforesaid punitive
measures taken against me;
6. As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing facts,
and for all legal intents and purposes it may well serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 10th day of November
2020 at the Municipality of La Trinidad, Benguet, Philippines.

ALADINE GUZMAN GODDI


Affiant
A01-18-000197

SUBSCRIBED AND SWORN to before me, this 10th day of November 2020, by the
Affiant whom I have identified through competent evidence of identity appearing below her name.

VICTOR B. SINGA JR.


Notary Public - Province of Benguet
NPPC No. 18-NC-0444 – Until December 31, 2020
Doc. No. ____ ; 2/F Lumiqued Bldg., JC 179 Km. 5 Pico, La Trin., Beng.
Page No. ____; PTR NO. 6316871, January 3, 2020
Book No. XVII; IBP LIFETIME MEMBER NO. 017081, Baguio-Benguet
Series of 2020. ROLL NO. 68089; Page No. 132; Book No. XXIX, May 26, 2017

You might also like