Republic of the Philippines) S.S.

City of Muntinlupa City

)
x ------------------------------------ x
AFFIDAVIT OF DAMAGE TO PLATE NUMBER
I, Jose Pablo A. Marcelo, Filipino, of legal age, single, and with
residential address at 16 Julian Felipe St. NSHA BF Homes Paranaque, after
being duly sworn to in accordance with law, hereby depose and state:
1. That I am the duly registered owner of a Toyota Corolla vehicle which
has a car plate number WFB 154.
2. That on November 2014, while I was cleaning my vehicle, I was
surprised to discover that my car plate was already damaged and detached from
its original position as evidenced by the photograph hereto attached as Annex
A.
3. That I have exerted effort in order to fix the said plate number but to no
avail due to the severity of the damage caused to the same.
4. That I am executing this Affidavit to attest to the truth of the foregoing
and in support of the claim for the reissuance of a replacement for my damaged
car plate number.

IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of

December, 2014 at ___________, Philippines.

_________________
Jose Pablo A. Marcelo
Affiant
SUBSCRIBED AND SWORN to before me, this ___ day of December
2014, by the affiant who exhibited to me his Drivers License number
_______________ issued at ________________ on ____________ and
which will expire on ___________.

Public
Doc. No.
Page No.
Book No.
Series of 2014.

Notary