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Affidavit of Loss: Republic of The Philippines) Done: City of Baguio) Ss

Lito Q. Camora filed an affidavit of loss stating that: (1) He owns a motorcycle issued with a key that was destroyed and replaced, but the replacement key was also destroyed; (2) The two destroyed keys were misplaced in his house despite diligent efforts to find them, so they are considered lost; (3) The lost keys have not been given or pledged to anyone else. He executed the affidavit to attest to these facts for legal purposes.

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Amanda Hernandez
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7K views1 page

Affidavit of Loss: Republic of The Philippines) Done: City of Baguio) Ss

Lito Q. Camora filed an affidavit of loss stating that: (1) He owns a motorcycle issued with a key that was destroyed and replaced, but the replacement key was also destroyed; (2) The two destroyed keys were misplaced in his house despite diligent efforts to find them, so they are considered lost; (3) The lost keys have not been given or pledged to anyone else. He executed the affidavit to attest to these facts for legal purposes.

Uploaded by

Amanda Hernandez
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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Republic of the Philippines )

DONE: CITY OF BAGUIO ) SS.

AFFIDAVIT OF LOSS
I, LITO Q. CAMORA, of legal age, single, Filipino Citizen with residence and postal
address at Jappa, Shilan, La Trinidad, Benguet, Philippines, after having been duly sworn to in
accordance with law do hereby depose and state:
1. That I am an owner of a Motor Cycle, RUSI, and was issued a KEY;
2. That however, the said KEY was destroyed (it was cut into pieces) and I went to the Office
of RUSI and was issued another KEY for my Motorcycle, unfortunately, said KEY, just like the
first, it was destroyed again, thus I cause the duplication of the KEY;
3. That said destroyed KEYS were lost, it was misplaced in my house and though I exerted
diligent efforts to locate such KEYS, but the same could no longer be found, hence, considered
forever lost;
5.The said TWO (2) KEYS has not been given nor pledged to anyone for any purpose
whatsoever, nor was it taken or confiscated by the authorities for any violation of any law or
traffic law or regulations;
6. That I am executing this affidavit to attest to the truthfulness of the foregoing facts and for
all legal intents and purposes that it may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this 13 th day of November,
2013 at Baguio City, Philippines.
LITO Q. CAMORA
Affiant
PhilHealth ID No. 04-224023815-7
SUBSCRIBED AND SWORN TO before me this 13th day of November, 2013 at Baguio
City, Philippines. Affiant personally appeared before me to be the same person who executed this
instrument as her free act and deed.
Doc. No. 081;
Page No. 17;
Book No. 6;
Series of 2013.

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