REPUBLIC OF THE PHILIPPINES)

DONE IN THE CITY OF BAGUIO) S.S.

AFFIDAVIT OF LOSS
I, ROMEO CASINGAL Y BAUTISTA, of legal age, married, a Filipino citizen, and
with residence and postal address at No. 8 Padre Zamora St., Baguio City, Philippines,
hereby declare and state under oath that:

1. I am the owner of a Motor Vehicle bearing plate number 3423 AF;

2. Last January 3, 2013 I parked the said Motor Vehicle at Governor Pack
Road, Baguio City about 3:00 P.M. in the afternoon ;

3. At about 4:00 P.M when I got back to my said Motor Vehicle I noticed that
my plate was already missing yet I don’t have any traffic violation ticket which would
indicate that I may have commited a Traffic Violation;

4. I exerted diligent and all possible means to locate the said Plate, however
all my efforts proved futile;

5. I then reported the matter to the Baguio City Police Office Station 7 last
February 22, 2013

6. The above-mentioned Plate was not confiscated and neither was it used for
any illegal purpose whatsoever;

7. I am executing this affidavit to attest to the truthfulness of the foregoing facts

for all intents and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 26 th day of February

2013 in the City of Baguio, Philippines.

ROMEO B. CASINGAL
Affiant

SUBSCRIBED AND SWORN to before me this 26th day of February 2013 in the
City of Baguio, Philippines. Affiant exhibited to me his Driver’s License No.
_______________________ valid until ________________.

Doc. No.
Page No.
Book No. II
Series of 2013