REPUBLIC OF THE PHILIPPINES)

CAMARINES NORTE ) S.S.

AFFIDAVIT OF LOSS
I, NOLAN I. ABABA, Filipino, married, of legal age with residence address at 089
Del Rosario St., Poblacion I, Basud, Camarines Norte, having been duly sworn to in
accordance with law, hereby depose and state: That-

1. In the year 204, I bought motorcycle with the following description:

Brand : Suzuki
Model : Shogun Pro
Color : Blue
Plate No. : EN4796

2. The said motorcycle was covered with original Official Receipt and
Certificate of Registration and being renewed on a yearly basis and
copies of the documents are with my mother;

3. However, sometime in the year 2014, I have tried to retrieve the OR/CR
from my mother but the same can no longer be found from her
cabinet;

4. Still I tried to find the documents of my motorcycle in every folders

where it may been filed at home but to no avail; and

5. Thus, despite earnest efforts to look for the OR/CR of my motorcycle

the same is now deemed exercise in futility;

6. I am executing this “Affidavit of Loss” to attest to the truthfulness of the

foregoing and for all legal intents and purposes this may otherwise
serve.

IN WITNESS WHEREOF, I hereby set my hand this ____ day of May 2017 at Daet,
Camarines Norte, Philippines.

NOLAN I. ABABA
Affiant

SUBSCRIBED AND SWORN to before me this _____ day of May 2017 at Daet,
Camarines Norte, affiant exhibiting to me his government issued ID No. _____________
with validity until ______________ as his competent evidence of identity.

NOTARY PUBLIC

Doc. No.: _______;

Page No.: ______;
Book No.:_______;
Series of 2017.