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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:
(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 _______________. 200__ at _________________________.
(Name Over Signature of Affiant)
SUBSCRIBED AND SWORN to before me, this ____ day of ______________, 200___ 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 200__.
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