REPUBLIC OF THE PHILIPPINES)

CITY OF GAPAN) S.S

AFFIDAVIT OF LOSS
I, ERNESTO M. JIMENEZ, of legal age, Filipino, married, and with residence and
postal code at Malimba, Gapan City, Nueva Ecija, 3105 under oath, depose and state
that:

1. I am the registered owner of one (1) unit, elf truck 16ft, described as follows:

Type: Elf truck

Model: 2008
Plate No.: UOF-231

2. As proof of ownership of the above-described truck, I was issued an Official

Receipt (OR) No. 1900088934 by the Gapan City District Office of the Land
Transportation Office (LTO).

3. Said Original Official Receipt and Certificate of Regitration were safely kept
inside our house; however, on 1 February 2021, upon looking for it, it was already
missing and suspected to be thrown by our maid.

4. I have exerted all efforts to locate at our house, but despite all the effort, I could not
find the same.

5. The original copies of the CR and OR were not assigned, mortgage, encumbered
and/or sold to any third person. The same was lost.

6. I execute this Affidavit to attest to the truthfulness foregoing facts, and to request for
duplicate copies of my lost CR and OR, and for whatever legal purpose it may
serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 2nd day of September
2020, IN Manila, Philippines.

ERNESTO G. JIMENEZ
Affiant

SUBSCRIBED AND SWORN to before me this _____ day of September 2020 in

Quezon City Philippines. Affiant exhibited to me his competent evidence of identity as
__________________.
 Notary Public

Doc. No____;
Page No. ___;
Book No. ___;
Series of 2020.