REPUBLIC OF THE PHILIPPINES)

QUEZON CITY...............................)

AFFIDAVIT OF LOSS

I, SIMPORIANO TORINO VILLARUZ JR , of legal age, single/married,

Filipino Citizen and with residence and postal address at 3504 HONDA ST.
PINAGKAISAHAN MAKATI CITY, having been duly sworn to in accordance
with law, do hereby depose and say:

1. That I am the holder of the TAPLOAD RECEIPT both in BANAWE

AUTOSHOP,

2. That the said TAPLOAD RECEIPT was lost sometime on or about

DECEMBER 29, 2023 in QUEZON CITY and in spite of most diligent,
search was to no avail;

3. That its lost was reported to the proper authorities concerned and, in my
request, to have a duplicate copy be issued;

4. That diligent effort to locate the same was exerted but to no avail:

That I am executing this affidavit to attest to the truth of foregoing facts and
for all whatever legal intents and purposes this may serve.

IN WITNESS WHEREOF, I have hereunder affixed my hand this ______ day

of ____________ at Quezon City. Philippines.

SIMPORIANO TORINO VILLARUZ JR

AFFIANT

SUBSCRIBED AND SWORN to before me this __________ in Quezon City,

Affiant exhibited to me his/her ___________________issued at _______on
_________.

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