REPUBLIC OF THE PHILIPPINES)
CITY OF ) S.S
AFFIDDAVIT OF DUPLICATE PLATE
We, DANILO & ANACLETA EMRALINO, of legal age, Filipino, married, and
resident of 5074 B Juan St., Sunshine Ville, City of Valenzuela, NCR, after having been duly
sworn to in accordance with the law hereby depose and say:
That I am the registered owner of a motor vehicle which is particularly described as
follows:
Make & Type: Mitsubishi
Engine Number: 4D56G006770
Chassis Number: PAEVB5SZLWB000515
Plate Number: WHB 380
MV File No. : 1312-00000172420
Year Model/Color: 1998, Gray
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);
That on August 29, 2023, I was inspecting the vehicle from a newly paint job, I noticed
that the registration plates were already damaged and when I asked the duty personnel to remove
the plates on the vehicle. I saw that the plate is cut in half, and the other one has holes and dents
on the sides. Also, as precaution I don’t want to cause any accident of falling debris (due to my
plates) on the road while driving the vehicle;
The said plate was not confiscated by any government authorities for violation of R.A.
4136 and other related laws;
I am executing this affidavit to attest to the veracity of my statements and to request for a
replacement of plate to the Land Transportation Office (LTO), Caloocan City.
IN WITNESS WHEREOF, I have hereunto set my hand this
_____________________________ at ___________________________.
DANILO EMRALINO & ANACLETA EMRALINO
Affiant
SUBSCRIBED AND SWORN, to before me this ______________________ at
________________________, Philippines. Affiant is personally known to me and was identified
by me through competent evidence identity as defined in the 2004 Rules on Notarial Practice
(A.M No. 02-8-13-SC). Affiant exhibited to me his Drivers License, with his photograph and
signature appearing thereon, with Drivers License No. N05-79-000542.
Witness my hand and seal this ________________________ 2023.
Doc. No.
Page No.
Book No.
Series of 2023
