REPUBLIC OF THE 

PHILIPPINES)

CITY OF MUNTINLUPA) S.S.

x----------------------------x

  

AFFIDAVIT OF LOSS OR/CR 

 I, MEGUMI AGUILOS MASUKO, of legal age, Filipino,

widow and a resident of 104 Makiling Ayala Alabang,

Muntinlupa, after having been duly sworn to in accordance

with law, depose and state THAT:

1. I am the registered owner of a motor vehicle

which is particularly described as follows:

    

             Make & Type :  ______________

             Motor Number : ______________

             Chassis Number : ____________

             Plate Number : ______________

             MV File No. : ________________

             Year Model/Color : ___________

2. As proof of ownership of the above-described

vehicle I was issued by the Land Transportation

Office, Official Receipt (OR) and Certificate of

Registration (CR);

3. The said documents while in my possession were

misplaced and could no longer be located in spite of

diligent efforts to locate them;

4. Said documents were neither transferred to other

persons/entity/financial institutions for any

consideration nor encumbered to guarantee financial

obligations with any financial institution;

5. Said documents were not confiscated by any

government authorities for violation of R.A. 4136 and

other related laws;

6. I shall assume responsibility or liability if in any

event I will use these documents for whatever illicit

transactions;
 7. I am executing this affidavit to attest to the

veracity of my statements and to support my request

for duplicate copies of the lost MVRR/MVMRR/OR/CR

with the Land Transportation Office (LTO).

IN WITNESS WHEREOF, I have hereunto set my

hand this ___________________ in Muntinlupa City,

Metro Manila, Philippines.

____________________

Affiant

SSS ID No. _____________

 SUBCRIBED AND SWORN TO before me

this ___________________ in

_________________, Philippines, affiant exhibiting to

me his/her competent evidence of identity by way of

__________________ issued at ______________

on __________________.
Doc. No. _____;

Page No. _____;

Book No. _____;

Series of 2023.