Affidavit of Loss of Certificate of Ownership Papers of Automobile

AFFIDAVIT
REPUBLIC OF THE PHILIPPINES
PROVINCE OF _________________
MUNICIPALITY OF _____________

SS

I, _______________________________________ , of legal age, single / married,

residing at ______________________________________________ , after being sworn
in accordance with law, depose and say:
That I am the true owner of an automobile, described as follows, to wit:
Make/Type : ___________
Motor No. : ___________
Chasis No. : ___________
Plate No. : ___________
Trade Name

C.R. No.
: __________
Current O.R. No.: __________
File No.
: __________
Classification
: __________
: ________________

That the said automobile had been duly registered in my name in the Motor
Vehicle Office in ____________________ for the year (or years) _________ ;
That the certificate of registration and other pertinent papers of ownership of said
automobile were among those burned and destroyed / loss in an earthquake / robbed on
_________________________;
That I made all possible means to locate it in all possible places that I might have
place it;
That said papers are now beyond recovery.
IN WITNESS WHEREOF, I have hereunto set my hand this _____day of
_______________________ , 20 ____, in the Municipality of ___________, Province of
_______________ , Philippines.

_______________________
(Signature of affiant)

SUBSCRIBED AND SWORN TO BEFORE ME, a notary public in and for

_________(City/Province)____________ this ____th day of ____________ 20___.
Affiant personally came and appeared with _____________(Competent Evidence of
Identity)______ issued by the _________(Government Agency)______ on ___(date)__
at ________(place)_________, bearing his photograph and signature, known to me as the
same person who personally signed the foregoing instrument before me and avowed
under penalty of law to the whole truth of the contents of said instrument.

ATTY _________________________________

Doc. No. 123

Page No. 69
Book No. VII
Series of 2007

COMMISSION NO. _____________________

NOTARY PUBLIC for _____________________
UNTIL DECEMBER 31, 200_
OFFICE: _____________________
ROLL NO. 00001
IBP Lifetime Roll No. 1234567 ; 01/07/07 ; ________
PTR NO 1234567 ; 01/07/07 ; ________
MCLE COMPLIANCE No. __________; July 7, 2007