REPUBLIC OF THE PHILIPPINES )

____________________________________ )

AFFIDAVIT OF LOSS

I, _______________________, ____ years old, Filipino, married, and a resident of

___________________, after having been duly sworn to in accordance with law, do
hereby depose and say that:

I am the same person executing this affidavit;

I am a the owner of a Honda TMX-155 which is still registered under the

name of ____________________;

The said motorcycle is covered by Certificate of Registration No.

_______________;

The I misplaced the said certificate of registration;

I exerted diligent effort to locate for it, but such effort proved futile
because the same could no longer be found. Hence, the same is now
deemed lost beyond recovery;

I am executing this affidavit in good faith, attesting to the truth of all the
foregoing statements as above-stated, asking the authorities concern to
merit this affidavit for the re-issuance and/or replacement of the lost
certificate of registration.

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

January 2020 in _________________.

Affiant

SUBSCRIBED AND SWORN to before me this on the date and place

above-written. Affiant exhibited to me his ______________________________ as
competent proof of identity.

Doc. No. 235;

Page No. 47;
Book No. V;
Series of 2020.