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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 by changing the data.

 

 

 

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.                           :

 

 

 

(Change the declaration below to the 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, 200___

 

Doc.  No. :  ________;

Page  No. :  ________;

Book No. :  ________;

Series of 20___.

 

 

 

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Last modified: 12 February 2014