AFFIDAVIT OF LOSS

REPUBLIC OF THE PHILIPPINES)

_____________________________ ) S.S. 

I, (Name of Affiant)., Filipino, of legal age, residing at (Address of Affiant), after having been sworn in accordance with law hereby depose and state:

That I am the true and lawful owner of a certain motor vehicle which is more particularly described as follows:

(Change the declaration below to the actual circumstances)

          That sometime in June of this year, I was looking for the original Certificate of Registration of my car but to my surprise, said Owner’s original Copy could not found;

          That I took pains to look for said Certificate of Registration, but to no avail;

          That I am executing this affidavit to attest to the truth of the foregoing and to request from the Land Transportation Office of Angeles City, a copy of said Certificate of Registration.

IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of _______________. 20___ at _________________________.

                                                                                              (Name Over Signature of Affiant)

          SUBSCRIBED AND SWORN to before me, this ____ day of ______________, 20___ in ___________________ City, with affiant exhibiting his CTC No. _______________ ,

Issued on ______________________ at _________________________.

                                                                                              NOTARY PUBLIC

                                                                                          Until December 31, 200___

Doc.  No. :  ________;

Page  No. :  ________;

Book No. :  ________;

Series of 20___.

Legal Form Note: Above is a sample affidavit of loss form for a Vehicle Certificate of Registration,

you can change this sample affidavit of loss form to a Loss of Driver's License or of any other item by changing the data.