Republic of the Philippines)

City of Zamboanga )s.s.

X---------------------------------X

AFFIDAVIT OF LOSS

I, KYLO REN, of legal age, married, Filipino citizen and a resident of

Zamboanga City Philippines, after having been duly sworn to in accordance with law,
hereby depose and say, that:

1. I am the owner of that certain motor-vehicle and as such I was issued an

Certificate of Registration by the Land Transportation Office (LTO for
brevity) of Zamboanga City, which is particularly described as follows, to
wit:

MAKE :
CHASSIS NO. :
ENGINE NO. :
SERIES :
PLATE NO. :
BODY TYPE :

2. Said Certificate of Registration was usually keep in an envelope and placed

inside the drawer in our house for safekeeping and easy access;

3. However, due to inadvertence and/or oversight said Certification of

Registration were no longer inside the drawer;

4. I exerted diligent efforts to locate for the same in other places, but all such
endeavors proved futile and to no avail;

5. For all intents and purposes, I am now declaring the above-mentioned

Certificate of Registration lost and beyond recovery;

6. I make these statements under oath and in good faith in order to establish
the fact of loss of the above-mentioned Certificate of Registration;

7. I execute this Affidavit to attest to the truth of the foregoing facts based on
my personal knowledge and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand on this 16th day of

November 2016 at Zamboanga City, Philippines.

KYLO REN

SUBSCRIBED AND SWORN to before me on this 16th day of November 2016 at

Zamboanga City, Philippines.

Doc. No. ____

Page No. ____
Book No. ____
Series of 2016