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Make CR No.
Engine No. Plate No.
Body Type Year Model
Chassis No.
That I further declare that the said described vehicle is free from liens
and/or encumbrances and shall defend its ownership from any /all
claims/whatsoever.
IN WITNESS WHEREOF, I have hereunto set my hands this 9th day of March
2019 in the __________________________________.
_____________________________
VENDOR
DRIVERS LIC. NO.
Issued on
At
ACKNOWLEDGMENT
AFFIDAVIT OF LOSS
Doc No._________;
Page No.________;
Book No.________;
Seri es of ________.