REPUBLIC OF THE PHILIPPINES )

Province of Negros Oriental )

City of Dumaguete )S.S.
x - - - - - - - - - - - - - - - - - - - - - -x

AFFIDAVIT OF LOSS

I, MELCHOR M. FLORES, Filipino, of legal age, married, and a

resident of Batiguel, Dumaguete City, Philippines, after being duly sworn
in accordance with law, depose and state:

1. That I am the registered owner of a certain motor vehicle, which is

more particularly described as follows:

Type of Body: Motorcycle without Sld

File No.: 072600000117461
Yr. Model: 2009
Color: Red
Plate No.: 2710GU

2. That as a registered owner, I was issued a Certificate of Registration

(C.R.) and an Original Receipt (O.R.) for my registration for the year
2016 by the Land Transportation Office of Dumaguete City,
Philippines;

3. That when I was looking for the Certificate of Registration inside the
utility box of my motorcycle, I could no longer find said
Certificate of Registration of the said motor vehicle.

4. That despite diligent search and efforts to locate the said documents,
I could no longer find the same such that I believe that they are now
lost beyond recovery.

5. As such, I am executing this Affidavit of Loss to attest to the

truth of the foregoing and to support my application for the
issuance of new Certificate of Registration in lieu of the one that was
lost.

IN WITNESS WHEREOF,I have hereunto set my hand

this_____________in the City of Dumaguete, Philippines.

MELCHOR M. FLORES
 Affiant

SUBSCRIBED AND SWORN to before me, this 28th day of November,

2016 in the City of Dumaguete, affiant exhibiting before me his Drivers
License with DL No. G02-75-020176, expiring on 2019-01-06 and issued
at Dumaguete City.

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of 2016.