Republic 

of the Philippines )
Province of ____________________) S.S.
City/Municipality of ______________)

AFFIDAVIT OF LOSS

I, Filipino, of legal age, single, and a resident of Mabuhay Textile, Malinta,

Valenzuela City, Philippines, after being duly sworn in accordance with law, depose and
state:
That I am the Driver of a Utility Vehicle/Elf, under the ownership of Keramix Specialty
Products Inc. more particularly described as follows:
Make & Series: Isuzu
Engine No. : 4BE1-152725
Chassis No. : ENKR-20050256-C
Plate No. : ZGJ749

That on or about August 1, 2020 , somewhere in Bocaue, Bulacan the rear license
plate of the said utility vehicle was lost;
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.
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 _____________ at
_____________, Philippines.

Affiant
DL No. _________________

SUBSCRIBED AND SWORN TO before me this _________________ at

________________________. Affiant exhibited to me her competent evidence of identity
written immediately below his name.

Notary Public

Doc. No. ____;

Page No. ____;
Book No. ____;
Series of 2020.
Republic of the Philippines )
Province of ____________________) S.S.
City/Municipality of ______________)

AFFIDAVIT OF LOSS

I, RYAN RENDAL, Filipino, of legal age, single, and a resident of Mabuhay Textile,

Malinta, Valenzuela City, Philippines, after being duly sworn in accordance with law, depose
and state:
That I am the Driver of a Truck, under the ownership of Keramix Specialty Products
Inc. more particularly described as follows:
Make & Series: RACAL DIONYSUS
Engine No. : YC4D12021D12F8G00008
Chassis No. : LWU5PM3C9GKM00150
Plate No. : CAH-2396

That on or about August 5, 2020 , somewhere in Olongapo City the rear license
plate of the said utility vehicle was lost;
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.
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 _____________ at
_____________, Philippines.

RYAN RENDAL
Affiant
DL No. _________________

SUBSCRIBED AND SWORN TO before me this _________________ at

________________________. Affiant exhibited to me her competent evidence of identity
written immediately below his name.

Notary Public

Doc. No. ____;

Page No. ____;
Book No. ____;
Series of 2020.