Escolar Documentos
Profissional Documentos
Cultura Documentos
AFFIDAVIT OF LOSS
1. That I am the holder of Original copy of Official Receipt (OR) and Certificate
of Registration (CR) and registered owner of motor vehicle particularly
describe as follow;
MAKE/BODY-----------------------------------------NISSAN/SUV
SERIAL/CHASISS NO.------------------------------WBYD21045821
ENGINE NO.------------------------------------------TD27048675T
PLATE NO.--------------------------------------------XDJ364
COLOR------------------------------------------------BROWN/GREEN
2. That sometime on April 2017, I discovered that the said original copy of
Official Receipt (OR) and Certificate of Registration (CR) were
lost/misplaced by me;
3. That I diligently searched and look for the said original copy of Official
Receipt (OR) and Certificate of Registration (CR) but I could no longer
locate the same;
4. That I execute this affidavit to establish and declare the fact of the loss of
the said Drivers License Card and for whatever purpose this affidavit may
serve best.
BENJAMIN C. TAN
Affiant
___________________
I, BENJAMIN C. TAN, of legal age, Filipino, married and a resident of Bajada, Davao City,
after having been duly sworn to in accordance with law do hereby depose and say:
1. That I am the registered owner and possessor of a motor vehicle particularly described
as:
MAKE/BODY-----------------------------------------NISSAN/SUV
SERIAL/CHASISS NO.------------------------------WBYD21045821
ENGINE NO.------------------------------------------TD27048675T
PLATE NO.--------------------------------------------XDJ364
COLOR------------------------------------------------BROWN/GREEN
That I caused the change color of the above-described motor vehicle from BROWN
GREEN to WHITE.
2. That I execute this affidavit to attest to the truth of the above facts and circumstances
and for whatever legal purpose it may serve.
BENJAMIN C. TAN
Affiant
____________________________