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Affidavit of Loss

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Earnest Money

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Legal Form Note: The example below is an Affidavit of Loss of a Vehicle Certificate of Registration, you can change this form to a Loss of Driver's License or of any other item that you may have lost by changing the information. Remove the textbox if not necessary.

 


AFFIDAVIT OF LOSS

 

 

REPUBLIC OF THE PHILIPPINES)

_____________________________ ) S.S. 

                                                     

 

I, (Name of Affiant)., Filipino, of legal age, residing at (Address of Affiant), after having been sworn in accordance with law hereby depose and state:

 

That I am the true and lawful owner of a certain motor vehicle which is more particularly described as follows:

 

MAKE              :

MOTOR NO.              :

SERIES            : 

SERIAL/CHASSIS NO. :

TYPE OF BODY :

PLATE NO.                :

YEAR MODEL   :

FILE NO.                   :

 

 

 

(Remove the table above if the item lost is not a vehicle certificate of registration & change the declaration below to suit your actual circumstances.)

 

          That sometime in June of this year, I was looking for the original Certificate of Registration of my car but to my surprise, said Owner’s original Copy could not found;

 

          That I took pains to look for said Certificate of Registration, but to no avail;

 

          That I am executing this affidavit to attest to the truth of the foregoing and to request from the Land Transportation Office of Angeles City, a copy of said Certificate of Registration.

 

IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of _______________. 20___ at _________________________.

 

 

_____________________________
(Name Over Signature of Affiant)

 

 

          SUBSCRIBED AND SWORN to before me, this ____ day of ______________, 20___ in ___________________ City, with affiant exhibiting his CTC No. _______________ ,

Issued on ______________________ at _________________________.

 

 

                                                                      NOTARY PUBLIC

                                                                 Until December 31, 20___

 

Doc.  No. :  ________;

Page  No. :  ________;

Book No. :  ________;

Series of 20_______.

 



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Sample of Affidavit of Loss of Vehicle Registration:

Affidavit of Loss Sample

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This Sample Affidavit of Loss of Cell Phone/SIM Card may be Revised indicate Loss of any item e.g. Wallet, Credit Card, Driver's License, ID, Money, Bag, etc.

Sample Affidavit of Loss

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