Republic of the Philippines)

DONE: CITY OF BAGUIO…..) S.S.

  
AFFIDAVIT OF LOSS
 
I, ANAMARIE M. JIMENEZ, of legal age, single, Filipino Citizen with
residence and postal address at 312 Siapno Road, Pacdal, Baguio City,
Philippines, after having been duly sworn to in accordance with law do hereby
depose and state that:
 
1. I am an owner of a certain Motor Vehicle and it has a Certificate of
Registration and which I mortgaged it covered by a Chattel Mortgage but
I was able to pay it, hence, I was issued a Cancellation of Mortgage;

2. On February 23, 2019 at around 7:30 o’clock in the evening I lost the
Certificate of Registration, Chattel Mortgage and Cancellation of
Mortgage which were put in an envelope. I was carrying many bags on
that night and maybe the envelope slipped out from the eco bag when I
was getting inside the jeep or when I got out. I exerted diligent effort to
locate the aforesaid documents but could not find the same, hence, lost
forever;

3. The said CERTIFICATE OF REGISTRATION, CHATTEL MORTGAGE

and CANCELLATION OF MORTGAGE were not been given nor pledged
to anyone for any purpose whatsoever, nor were taken or confiscated by
the authorities for any violation of any law;

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

facts and for all legal intents and purposes that it may serve.

  IN WITNESS WHEREOF, I have hereunto set my hand this 25 th day of

February, 2019 at Baguio City, Philippines.
 
 
ANAMARIE M. JIMENEZ
AFFIANT
Driver’s Lic. ID No. AO1-02-083825
Exp. Date: 2022/02/08
 
            SUBSCRIBED AND SWORN TO before me this 25th day of February,
2019 at Baguio City, Philippines. Affiant personally appeared before me to be
the same person who executed this instrument as her free act and deed.

 MODESTO T. ANDONG
Notary Public
Commission No. 39-NC-18-R/Until: Dec. 31, 2019
PTR No. 3954050/1-3-2019/Baguio City
IBP No. 02793/1-3-2019
Roll No. 31289/5-15-81/Manila
Doc. No. 261; MCLE COMPLIANCE No. VI-0000192/June 14, 2016
Page No. 53; BIR TIN No. 121-017-652
Book No. 34; No. 19, 2nd Floor Old Market Bldg.,
Series of 2019. Magsaysay Ave., Baguio City, Philippines