REPUBLIC OF THE PHILIPPINES )
PROVINCE OF BUKIDNON ) S.S.
MUNICIPALITY OF MARAMAG )
X-------------------------
AFFIDAVIT OF LOSS
I, ________________, of legal age, Filipino, married, and a resident
of_______________, Philippines, after having been duly sworn in accordance with law,
hereby depose and state:
1. That I am driving a TRUCK with _________ registered under the name
of my mother, _______________;
2. That sometime on July 2017, while I was driving the vehicle on the way to
_____________to deliver sugarcane, I noticed that the plate number of the
truck was already missing;
3. That I exerted efforts to retrieve the plate number through going back to
the places where I have been that day, but it proved to be fruitless;
4. That I lost the plate number through accident and with the exercise of
diligence of a reasonable and prudent person exercising care over his things
and circumstances;
5. That I am executing this affidavit in order to attest to the veracity of the
foregoing facts and for whatever legal purpose this may serve;
IN WITNESS WHEREOF, I have hereunto set my hand this _______________
at Maramag, Bukidnon, Philippines.
AAA
Affiant
SUBSCRIBED AND SWORN to before me, this _______________ by affiant who
exhibited to me his _______________issued at Malaybalay, Bukidnon, Philippines as his
Competent Evidence of Identity (CEI) in accordance with the 2004 Rules on Notarial
Practice. I HEREBY CERTIFY THAT HE UNDERSTOOD THE CONTENTS OF THIS
AFFIDAVIT AND THAT THE SAME IS TRUE AND CORRECT ACCORDING TO HIS OWN
KNOWLEDGE AND BASED ON AUTHENTIC RECORDS.
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2017.