REPUBLIC OF THE PHILIPPINES)

PROVINCE OF NUEVA VIZCAYA) S.S.

MUNICIPALITY OF BAYOMBONG)

AFFIDAVIT OF LOSS

I, IVAN ALFONSO ALBERTO DULAWAN, of legal age, married,

Filipino citizen, and presently residing at Brgy. Mungayang, Kiangan, Ifugao,
after having been duly sworn to an oath in accordance with law, do hereby
depose and say that:

1. That I am an employee of K-Servico, located at JP Rizal Avenue, Brgy.

Quirino, Solano, Nueva Vizcaya;

2. That as an employee, I am the bonafide holder and possessor of

ORIGINAL copy of the Certificate of Registration (C.O.R) and an
Official Receipt (O.R) of a motorcycle with plate number BC34031,
under the name of IVAN ALFONSO ALBERTO DULAWAN and
issued by Land Transportation Office, Bayombong, Nueva Vizcaya.
Photocopies of said OR and CR are hereto attached as Annex “A” and
“B” and made an integral part hereof;

3. Said Certificate of Registration and Official Receipt were always in my

possession however, sometime in December 2018, I noticed that the
Certificate of Registration and Official Receipt were missing from the files
where I placed it and despite earnest efforts, I failed to find it;

4. Finding the futility of recovering the Original Copy of said C.O.R. and
O.R, it is hereby declared that the same are considered lost and beyond
recovery;
5. I am executing this affidavit of loss to attest to the veracity of the foregoing
statements and to support my application for the issuance of another
Certificate of Registration and Official Receipt in lieu of the lost one.

IN WITNESS WHEREOF, I have hereunto set my hand on this affidavit

th
this 8 day of January 2019 at Bayombong, Nueva Vizcaya.

IVAN ALFONSO ALBERTO DULAWAN

Affiant
 SUBSCRIBED AND SWORN TO before me this 8th day of January 2019
at Bayombong, Nueva Vizcaya, affiant having exhibited to me his competent
evidence of identity bearing his name and signature.
REPUBLIC OF THE PHILIPPINES)
PROVINCE OF NUEVA VIZCAYA) S.S.
MUNICIPALITY OF BAYOMBONG)

AFFIDAVIT OF LOSS

I, IVAN ALFONSO ALBERTO DULAWAN, of legal age, married,

Filipino citizen, and presently residing at Brgy. Mungayang, Kiangan, Ifugao,
after having been duly sworn to an oath in accordance with law, do hereby
depose and say that:

6. That I am an employee of K-Servico, located at JP Rizal Avenue, Brgy.

Quirino, Solano, Nueva Vizcaya;

7. That as an employee, I am the bonafide holder and possessor of

ORIGINAL copy of the Certificate of Registration (C.O.R) and an
Official Receipt (O.R) of a motorcycle with plate number 024403, under
the name of RENY I. BUH-HONG and issued by Land Transportation
Office, Bayombong, Nueva Vizcaya. Photocopies of said OR and CR are
hereto attached as Annex “A” and “B” and made an integral part hereof;

8. Said Certificate of Registration and Official Receipt were always in my

possession however, sometime in December 2018, I noticed that the
Certificate of Registration and Official Receipt were missing from the files
where I placed it and despite earnest efforts, I failed to find it;

9. Finding the futility of recovering the Original Copy of said C.O.R. and
O.R, it is hereby declared that the same are considered lost and beyond
recovery;

10. I am executing this affidavit of loss to attest to the veracity of the foregoing
statements and to support my application for the issuance of another
Certificate of Registration and Official Receipt in lieu of the lost one.

IN WITNESS WHEREOF, I have hereunto set my hand on this affidavit

th
this 8 day of January 2018 at Bayombong, Nueva Vizcaya.

IVAN ALFONSO ALBERTO DULAWAN

Affiant
SUBSCRIBED AND SWORN TO before me this 8th day of January 2019 at
Bayombong, Nueva Vizcaya, affiant having exhibited to me his competent
evidence of identity bearing his name and signature.