Republic of the Philippines )

City of Paraήaque ) S.S.

x----------------------------------------------x
AFFIDAVIT OF LOSS
MOTOR VEHICLE L.T.O. CERTIFICATE OF REGISTRATION

KNOW ALL MEN BY THESE PRESENTS:

I, _________________________, Filipino, single/MARRIED, of legal age and residing at

__________________________________________________, after having been duly sworn to in accordance with
law, HEREBY SOLEMNLY DEPOSE AND STATE THE FOLLOWING:

1. That I am the duly registered owner of a 4-door Sedan-Gas motor vehicle with PLATE NUMBER:
_________ specifically a Gold-Silver 2006 Mitsubishi Lancer 4-door sedan under Certificate of
Registration No. ___________ dated ____________________, with Engine No. __________, and Chassis
No. _____________ respectively;

2. That the original copy of the LTO Certificate of Registration afore-mentioned was discovered only today
to be missing or unlocated or otherwise now considered lost, despite all the futile efforts to find or locate
same was undertaken and exhausted;

3. That in order to preclude violation of transportation laws, I am executing herein affidavit in detail for LTO
(and TMG-HPG) purposes, that will serve as legal documentation that the 1 st issued original LTO
Certificate of Registration is presently no longer readily available in my possession; and finally;

4. That the photocopy or reproduction copy of the subject certificate and the latest LTO MV registration
O.R. are both ATTACHED HEREIN and made as an integral part of this affidavit, and to additionally evince
support for the above-mentioned facts or vehicle details and that registrant-affiant is in good faith and
with no intention of any regulation (direct or indirect) circumvention, more so mislead authority and the
public.

As such, I am thus executing this affidavit to attest to the truth of the foregoing; wherefore to secure from the
appropriate Land Transportation Office the immediate replacement or re-issuance of MV Certificate of
Registration.

IN WITNESS WHEREOF, I have hereunto set my hand this 10th day of April 2024 in Paraήaque City, Metro Manila,
Philippines.

____________________________
Affiant

SUBSCRIBED AND SWORN to before me, this ___ day of April 2024 by the above Affiant whom I have
identified through competent evidence of identity and who exhibited his Tax Identification Number (TIN)
card with No. _____________ issued at BIR-________ City.

NOTARY PUBLIC
Doc. No. ___;
Page No. ___;
Book No. ___;
Series of 2024