REPUBLIC OF THE PHILIPPINES )

PROVINCE OF RIZAL ) S.S.

AFFIDAVIT OF LOSS

I, ___________, of legal age, married, Filipino, and a resident of

Lobarbio St., Brgy. Bilibiran, Binangonan, Rizal after having sworn in
accordance with the law, do hereby, depose and state that:

1. I am the owner of an orange/black Honda Click 125i motorcycle

with Plate Number 597NQQ and covered by Certificate of Registration
Number 40781352-3 registered on January 6, 2021 and Official Receipt No.
0484-000000053371;

2. Said motorcycle and its motor plate were in my possession;

3. On or about November 5, 2022, at around 7:00 PM, while

traversing the area of Mataas na Lupa, Trece Martires-Indang Road in
Cavite, I lost said motor plate with Plate No. 597NQG; it was somehow
detached from my motorcycle and fell off the road;

4. I returned to the area where I believe it was lost to locate it, but
despite diligent efforts, I could no longer find nor locate the same and I
believe that it is truly lost;

5. I am executing this affidavit to attest to the truthfulness and

veracity of the foregoing statements and use the same for whatever legal
purpose it may serve.

AFFIANT FURTHER SAYETH NONE.

IN WITNESS WHEREOF, I have hereunto set my hand this

__________________ in ________________.

RONI D. ADO
Affiant

SUBSRIBED AND SWORN to before me this ________________ at

Binangonan, Rizal, Philippines, by the affiant who exhibited to me his
_____________ with number _________________ issued on _____________
at ________________.
Notary Public

Doc. No.: _____

Page No.: _____
Book No.:______
Series of 2022.