REPUBLIC OF THE PHILIPPINES )
PROVINCE OF LAGUNA ) S.S.
VICTORIA, LAGUNA )
x------------------------x
AFFIDAVIT OF LOSS
I, , married, Filipino, of legal age, and with residence and postal address at M. L. Quezon St.,
Brgy., after having been duly sworn to in accordance with law, hereby depose and state:
1. That I am the lawful and registered owner of a motor vehicle described as
follows;
2. That the plate number attached at the above-described motor vehicle was accidentally
detached without my knowledge;
3. That the said plate number was inadvertently lost through no fault of my own;
4. That despite diligent search and efforts to locate said plate number, I could not find the same
such that I now have reasons to believe that it is now lost and cannot be recovered;
5. That the said plate number has never been confiscated by any law enforcement agency;
6. That I executed this Affidavit of Loss in order to attest under oath the facts surrounding the
loss of the above-mentioned plate number and to request the issuing agency to issue a new
one in lieu thereof;
7. That this Sworn Statement was executed not for purposes of fraud or deceit.
Further affiant sayeth naught.
IN WITNESS WHEREOF, I have hereunto set my hand this 12th day of July, 2024 in
Victoria, Laguna, Philippines.
