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Affidavit of Loss or CR

Erlinda Floro Johnson, a resident of Alaminos City, Philippines, has executed an affidavit of loss for her motor vehicle's Official Receipt and Certificate of Registration, which she has misplaced despite diligent efforts to locate them. She confirms that the documents were not transferred or confiscated and assumes responsibility for any misuse. This affidavit is intended to support her request for duplicate copies from the Land Transportation Office.

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Jayson Vanguardia
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11 views1 page

Affidavit of Loss or CR

Erlinda Floro Johnson, a resident of Alaminos City, Philippines, has executed an affidavit of loss for her motor vehicle's Official Receipt and Certificate of Registration, which she has misplaced despite diligent efforts to locate them. She confirms that the documents were not transferred or confiscated and assumes responsibility for any misuse. This affidavit is intended to support her request for duplicate copies from the Land Transportation Office.

Uploaded by

Jayson Vanguardia
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 Aalaminos ) S.S.


x-----------------------------------x

AFFIDAVIT OF LOSS OR/CR

I, ERLINADA FLORO JOHNSON, of legal age, Filipino, widow and a resident of


SAbaro, Brgy. Poblacion, Alaminos City, PAngasinan, 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 : ______________ Motor Number : ______________

Chassis Number : ____________ Plate Number : ______________

MV File No. : ________________ Year Model/Color : ___________

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

IN WITNESS WHEREOF, I have hereunto set my hand this 2 nd day of April, 2025
in Alaminos City, Pangasinan Philippines.

ERLINDA FLORO JOHNSON


Affiant
SC ID No. 16553-03/12/2020

SUBSCRIBED AND SWORN to before me, this ____ day of __________ 2025,
in the City of Alaminos.

Doc. No. ______;


Page No. ______;
Book No. ______;
Series of ______;

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