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Affidavit of Loss

1. Nenita Solidad Mercado owns a red Honda Wave 100 motorcycle with plate number 7H-05-37502 and lost her official receipt and certificate of registration documents. 2. She swears in an affidavit that the documents were misplaced despite diligent efforts to find them and that they were not transferred, encumbered, or confiscated by authorities. 3. She assumes responsibility if the lost documents are used for illicit purposes and executes the affidavit to support her request for duplicate copies from the Land Transportation Office.

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RICKY BALDADO
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97 views1 page

Affidavit of Loss

1. Nenita Solidad Mercado owns a red Honda Wave 100 motorcycle with plate number 7H-05-37502 and lost her official receipt and certificate of registration documents. 2. She swears in an affidavit that the documents were misplaced despite diligent efforts to find them and that they were not transferred, encumbered, or confiscated by authorities. 3. She assumes responsibility if the lost documents are used for illicit purposes and executes the affidavit to support her request for duplicate copies from the Land Transportation Office.

Uploaded by

RICKY BALDADO
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)
CITY OF TANJAY            ) S.S.
x----------------------------x
  

AFFIDAVIT OF LOSS OR/CR 

 I, NENITA SOLIDAD MERCADO, of legal age, Filipino, married and a


resident of Amlan, Negros Oriental Philippines, 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 : HONDA WAVE 100
             Plate Number : 7H-05-37502
             Color : RED

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 OR/CR with the Land
Transportation Office (LTO).

IN WITNESS WHEREOF, I have hereunto set my hand


this ___________________ in Tanjay City, Negros Oriental, Philippines.

NENITA SOLIDAD MERCADO


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 2023.

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