JEFF Affidavit-of-Loss-Plate
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RaysunArellanoJEFF Affidavit-of-Loss-Plate
Uploaded by
RaysunArellanoREPUBLIC OF THE PHILIPPINES)
CITY OF MANILA )S.S.
AFFIDAVIT OF LOSS
1. ______________________, of legal age, Filipino and a resident of
_____________________ , after being sworn to in accordance with law, hereby depose and say,
THAT:
2. I am the registered owner / operator of the motor vehicle described as follow:
Make / Type : ____________________
Motor No. : _____ _______
Chassis No. : __________________
Plate No. : __________________
3. On or about ________ of __________________, my vehicle was properly parked at
__________________. When I returned to retrieve the above-described vehicle on ___________,
I noticed that its plate is missing;
4. I lost no time in diligently trying to locate the said plate but all efforts exerted proved
futile and to no avail, and that the same is considered lost or stolen and beyond recovery;
5. The said lost plate was never lent to another person or entity nor confiscated by any
other law enforcement agency;
6. I bind myself to surrender the said plate to the district office that issued the same in
the event that said plate is recovered;
7. If the DOTC thru the LTO/LTFRB, after inquiry, has found me responsible for the
unauthorized use of the herein reported lost plates, I hereby signify my conformity to be meted
the administrative fines and penalties due and imposed thereon, including the ground of the unit/s
covered by the Certificate of Public Convenience issued therefore, with waiver and desistance in
my part for any claim or action by reason of the aforesaid punitive measures taken against time.
8. Purpose of this Affidavit of Loss is for LTFRB in securing a replacement for lost plate.
9. I am executing this affidavit for the aforesaid purpose/s as well as for attesting to the
truth of the statements herein declared, subject to the rules on perjury.
AFFIANT FURTHER SAYETH NAUGHT.
_______ ______________________
Affiant
Driver’s License No. ____________
Issued on____________________
SUBSCRIBED and SWORN to before me this ________ day of __________ 2018 at
__________ City, affiant exhibited to me his Driver’s License.
Doc. No. _____________
Page No. _____________
Book No. ____________
Series of 2018