Affidavit of Loss LTO VFS 488

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(REPUBLIC OF THE PHILIPPINES)

CITY OF DAVAO

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

AFFIDAVIT OF LOSS OR

I, Rinabeth L. Arellano of legal age, married, Filipino and resident of Lot 3586-1 Purok San
Andres< Barangay Indangan, Davao City, after having been sworn to in accordance with law, hereby
depose and state:

1. That I am the registered owner of the motorcycle described below as to wit:

Make & Type :Mitsubishi SUV


Motor Number :4D56UCEF3149
Chasis Number :MMBGNKG40DD008707
Plate Number VFS 488

2. That, as proof of ownership of the above described motorcycle I was issued by the Land
Transportation Office, Official Receipt (OR) as proof of payment and Certificate of Registration
(CR);

3. That the said documents while in my possession were misplaced and could no longer be located
inspite of exerting efforts of locating them;

4. That the said documents were not in the possession of any bank institutions or lending companies
by reason of encumbrance or chattel mortgage of the subject vehicle;

5. That the said documents were not confiscated by any government authorities in violation of R.A.
4136 and other related laws;

6. That I shall assume any responsibilities or liability if any event I will use these documents for
whatever elicit transactions;

7. That I am executing this affidavit to attest to the veracity of my statement and to support the same
in its request for duplicate copies of the lost OR/CR at the Land Transportation Office (LTO)
where is has a hand over subject;

8. That I bind myself criminally civilly and administratively liable and will assume full
responsibility for any 3rd party claim, and I hereby hold the Land Transportation Office or any of
its employees free from any liability arising from any claim for damages as a result of the
registration of the vehicle and or issuance of replacement certificate of registration.

9. IN WITNESS HEREOF, I hereunto affix my signature this ______________________ in Davao


City

Rinabeth L. Arellano
Affiant
CRN – 0009-2034937-5

SUBSCRIBED AND SWORN TO before me this ____day of ________2021 at Davao City


Philippines. Affiant exhibiting to me his valid identification as stated above

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