AFFIDAVIT OF LOSS

 
 
REPUBLIC OF THE PHILIPPINES)
Baguio City) S.S. 
                                                     
 
I, ALBERTO R. MOLINA., Filipino, of legal age, residing at #74 Udiao, Udiao, Rosario, La
Union 8504. 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:
 
MAKE                   : HONDA MOTOR NO.                      : MCO 7024817
SERIES                :  SERIAL/CHASSIS NO.      :KRS 10-034-024817
HONDA/MC
TYPE OF BODY    : MC PLATE NO.                        : BL 6692
YEAR MODEL       : 2005 FILE NO.                           : 0220-10619
  COLOR : RED
 

 
          That sometime in October 2009, I was looking for the original Certificate
of Registration of my Motorcycle 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 Baguio City, a copy of said
Certificate of Registration.
 
IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of February. 2011 at
Baguio City Philippines;
 
                  
                   
ALBERTO R. MOLINA
        
 
          SUBSCRIBED AND SWORN to before me, this ____ day of February, 2011 in Baguio
City, with affiant exhibiting his CTC No. _______________ ,
Issued on ______________________ at _________________________.
 
 
                                                                                               NOTARY PUBLIC
                                                                                          Until December 31, 20
 
Doc.  No. :  ________;
Page  No. :  ________;
Book No. :  ________;
Series of 20___.