REPUBLIC OF THE PHILIPPINES)

MUNICIPALITY OF ODIONGAN, ROMBLON) S.S

AFFIDAVIT OF LOSS

I, JUDY AI M. PASTOR, Filipino, of legal age, and a resident of

Brgy.Tulay, Odiongan, Romblon, Philippines, after being duly sworn to
in accordance with law, hereby depose and state:

1. That I am the registered owner of a certain motor

vehicle;
2. That when I was about to register the said motor vehicle
for year 2024 I could no longer find said Official Receipt
and Certificate of Registration of the said motor vehicle;
3. That despite diligent search and efforts to locate the said
documents, I could no longer find the same such that I
believe that they are now lost beyond recovery.
4. As such, I am executing this Affidavit of Loss to attest to
the truth of the foregoing and to support my application
for the issuance of new Official Receipt and
Certificate of Registration, in lieu of the ones that were
lost.

IN WITNESS WHEREOF, I have hereunto affix my signature

this_____________ at Odiongan, Romblon, Philippines.

______________________________
JUDY AI M. PASTOR
Affiant

SUBSCRIBED AND SWORN TO before me this

_______________at Odiongan, Romblon, Philippines.

Doc. No._________
Page No._________
Book No._________
Series of 2024