REPUBLIC OF THE PHILIPPINES)
PROVINCE OF BUKIDNON) S.S
MUNICIPALITY OF)
AFFIDAVIT OF LOSS
I, , of legal age, Filipino citizen, married and a resident of Barangay,
Bukidnon, after having been duly sworn to in accordance with law do hereby
depose and say:
1. That I am the owner of one (1) unit color red SUZUKI
MOTORCYCLE covered by Certificate of Registration No.
and Official Receipt No. with Plate No. , Engine No.
and Chassis No., registered under the name of;
2. That sometime on December 2020, I discovered that the above-
mentioned Certificate of Registration and Official Receipt which I
purposely placed inside my plastic envelope for safekeeping was
lost;
3. That I believe while I was getting the said document/s for any
important transaction/s, I must have inadvertently left it
somewhere;
4. That diligent efforts were exerted to locate the above-mentioned
documents but the same proved to no avail hence, I consider them
lost forever;
5. That I am executing this affidavit to attest to the veracity of the
foregoing facts and for whatever worth this may serve best;
IN WITNESS WHEREOF, I have hereto affixed my hand this 19 th day
of June, 2024 in Bukidnon, Philippines.
AFFIANT
SUBSCRIBED AND SWORN to before me this 19 th day of June, 2024
at Bukidnon, with the affiant exhibiting to me his
Doc. No.
Page No.
Book No.
Series of 2024
