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_____________________________ ) S.S.
AFFIDAVIT OF LOSS
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:
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;
IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of _______________.
20___ at _________________________.
Affiant
______________________________ ____________________________
ACKNOWLEDGMENT
1
REPUBLIC OF THE PHILIPPINES)
_____________________________) SS.