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Affidavit of Loss - Cert of Registratio

Jennifer Pana Cuevas filed an Affidavit of Loss stating that she lost her Certificate of Registration number 191756357 issued by the Land Transportation Office in April 2016 despite searching. She is executing this affidavit to support her application to renew the vehicle's denomination from single to one having a side car. The affidavit was sworn before a notary on May 2019 in Dumaguete City, Philippines.

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Frances Sanchez
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64 views2 pages

Affidavit of Loss - Cert of Registratio

Jennifer Pana Cuevas filed an Affidavit of Loss stating that she lost her Certificate of Registration number 191756357 issued by the Land Transportation Office in April 2016 despite searching. She is executing this affidavit to support her application to renew the vehicle's denomination from single to one having a side car. The affidavit was sworn before a notary on May 2019 in Dumaguete City, Philippines.

Uploaded by

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

Dumaguete City ) S.S.


Negros Oriental

AFFIDAVIT OF LOSS

I, JENNIFER PANA CUEVAS, of legal age, Filipino, single, and a resident of


Purok Malinawon, Brgy. Talay, Dumaguete City, subscribing under oath, hereby depose
and state:

1. That I am the holder of a CERTIFICATE OF REGISTRATION with C.R. No.


191756357 issued by the Land Transportation Office;

2. That sometime on April, 2016, I misplaced the said CERTIFICATE OF


REGISTRATION;

3. That despite diligent search and efforts to locate the said CERTIFICATE OF
REGISTRATION, I could not find it such that I now believe that it is lost beyond
recovery;

4. As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing
and to support my application to renew the vehicle’s denomination from single
(without side car) to one having side car.

In witness whereof, I have hereunto set my hand this ____________ at Dumaguete


City, Philippines.

JENNIFER PANA CUEVAS


Affiant
Identification Card: Postal Identity Card
Identification Card No.: K26180659222 P

ACKNOWLEDGMENT

SUBSCRIBED and SWORN to before me this ____ day of May, 2019, personally
appeared Affiant who is known to me and identified by me by competent evidence of
identity in accordance with the 2004 Rules on Notarial Practice, who exhibited to me the
above identification card, who executed this foregoing Affidavit of Loss and
acknowledged that the same is her free and voluntary act and deed. This instrument
consisting of one page, including this page whereon this acknowledgement is written
has been signed by Affiant.

            IN WITNESS WHEREOF, I have hereunto affixed my signature and notarial seal
this _____ day of May, 2019 in Dumaguete City, Philippines.

Doc. No._____
Page No.____
Book No. ____
Series 2019.

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