AFFIDAVIT OF LOSS 1. _________________________, of legal age, Filipino and a resident of ____________________________________________________,after being sworn to in accordance with law, hereby depose and say, THAT: 2. I am registered owner /operator of the motor vehicle described as follows: Mae/!ype : ___________ ".#. $o. : __________ Motor $o. : ___________ "%rrent &.#. $o.: __________ "hasis $o. : ___________ File $o. : __________ 'late $o. : ___________ "lassification : __________ !rade $ame : ________________ 'osition of (ffiant : / / "hairman / / )eneral Manager / / 'resident / / &wner 2. &n or abo%t ___ (.M./'.M. of __________, my vehicle was properly pared at _________________. *hen I ret%rned to retrieve the above+described vehicle on ____________ I noticed that one/both of its plates is/are missing. ,. I lost no time in diligently trying to locate the said plate/s b%t all efforts e-erted proved f%tile and no to avail, and that the same is considered lost or stolen and beyond recovery. /. !he said lost plate/s was/were never lent to another person or entity nor confiscated by any other law enforcement agency. 0. I bind my self to s%rrender the said plates to the district office that iss%ed the same in the event that said plates are recovered. 1. If the 2&!" thr% the 3!&/3!F#4, after in5%iry, has fo%nd me responsible for the %na%thori6ed %se of the herein reported lost plates, hereby signify my conformity to be meted the administrative fines and penalties d%e and imposed thereon, incl%ding the gro%nd of the %nit/s covered by the "ertificate of '%blic "onvenience iss%ed thereof, with waiver and distance on my part for any claim or action by reason of the aforesaid p%nitive meas%res taen against me. 7. '%rpose of this (ffidavit of 3oss: /_/ For 3!F#4 'etition for 2ropping and 8%bstit%tion /_/ For 3!F#4 'etition for 8ale and !ransfer, and/or /_/ For sec%ring a replacement for lost plates 7. I am e-ec%ting this affidavit for the aforesaid p%rpose/s as well as for attesting to the tr%th of the statements herein declared, s%b9ect to the r%les on per9%ry. AFFIANT FURTHER SAYETH NAUGHT. _______________________ (ffiant "om. !a- "ert. $o._______ Iss%ed at ______on_______ SUBSCRIBED and SWORN to before me this ____day of ________ 2::/ at ;%e6on "ity, affiant e-hibited to me his/her, comm%nity ta- certificate. 2oc. $o.______ 4oo $o.___ 'age $o._____ 8eries of 2:::