Republic of the Philippines )

Province of Tarlac ) S.S.

City of Tarlac )

AFFIDAVIT OF LOSS

I, EDGARDO Z. RAMILO, Filipino, of legal age, and a resident of Abagon,

Gerona, Tarlac, Philippines, after being duly sworn in accordance with law, depose and
state:

1. That I am the duly authorized driver of a certain motor vehicle, more particularly
described as follows:

Make : Mitsubishi
Motor No. : 4D56AAS1935
Chassis No. : PAEL65NYHHB000084
Plate No. : CXP 560
2. That yesterday, November 29, 2018, the car is parked in Metro Shoppers Mall
Parking Area, which is a usual parking space for vehicles;
3. When I got back to the car, the front license plate of the said vehicle was lost;
4. That despite diligent search and efforts to locate the said license plate, I could not
find the same such that I now believe that they are now lost beyond recovery.
5. As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing
and to support the application for the issuance of a new one in lieu of the one that
was lost.

IN WITNESS WHEREOF, I have hereunto set my hand this 29th day of November
2018 at Tarlac City, Philippines.

EDGARDO Z. RAMILO
Affiant

SUBSCRIBED AND SWORN TO before me this 29th day of November 2018 at

Tarlac City, Philippines, affiant exhibiting to me his valid proof of identification.

Doc No.: 169

Page No. 34;
Book No. CCXIV
Series of 2018