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Affidavit of Loss Plate

Krisha Marie C. Tamba, an authorized driver, declares the loss of the rear plate of her Nissan SUV on November 29, 2024, while driving towards San Jose de Buenavista, Antique. She affirms that the plate was not confiscated by authorities and is executing this Affidavit of Loss to request a replacement or temporary plate from the Land Transportation Office in Iloilo City. The affidavit is sworn before a notary public in Iloilo City.

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11 views1 page

Affidavit of Loss Plate

Krisha Marie C. Tamba, an authorized driver, declares the loss of the rear plate of her Nissan SUV on November 29, 2024, while driving towards San Jose de Buenavista, Antique. She affirms that the plate was not confiscated by authorities and is executing this Affidavit of Loss to request a replacement or temporary plate from the Land Transportation Office in Iloilo City. The affidavit is sworn before a notary public in Iloilo City.

Uploaded by

jhorielconcepcion
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

In the city of Iloilo

X-----------------------x

AFFIDAVIT OF LOSS
I, KRISHA MARIE C. TAMBA, of legal age Filipino citizen, single and a resident of Centro Poblacion,
Culasi, Antique, after having duly sworn to in accordance with law hereby depose and say that:

That I am the authorized driver of a vehicle which is particularly described as follows:

Make: Nissan
Model: SUV WAGON 5 Door
Engine Number: TD42-090373
Chassis Number: CRGY60-R00573
Plate Number: FDG 714
Color: Not Indicated

As proof of ownership of the above-described vehicle I was issued by the Land Transportation
Office, Official Receipt (O.R.) and Certificate of Registration (C.R.);

That on November 29, 2024 I was driving said vehicle towards San Jose de Buenavista, Antique.
I notice that my rear plate was missing and nowhere to be found despite diligent search;

Said plate were not confiscated by any government authorities for violation of R.A. 4136 and
other related laws;

As such, I am executing the Affidavit of Loss to attest to the veracity of my statements and to
request for a replacement of plate or authorization to use temporary plate to the Land Transportation
Office, in Iloilo City, Region VI.

IN WITNESS HEREOF, I here unto set my hand this ____day of ________________ at Iloilo
City, Philippines.

KRISHA MARIE C. TAMBA


Affiant

SUBSCRIBED AND SWORN to before me this ___day of _________________, at Iloilo City,


Philippines. Affiant exhibited his driver’s license no. F03- 18-008853 issued by LTO.

Doc. No.____
Page No.____
Book No.____
Series of ____

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