Republic of the Philippines)

Province of Camarines Sur)

Municipality of Ocampo)s.s

AFFIDAVIT OF LOSS
I, NORMA P. IRAULA Filipino, of legal age, married and a resident of
Brgy. Poblacion East, Ocampo, Camarines Sur, under oath states that:

1. Sometime in 2009, my son-in-law, Christian R. Belarmino, was issued by the

Office of the Municipal Mayor of Ocampo, Camarines Sur, a SIDECAR
PLATE NUMBER by virtue of him having registered my tricycle his name;

2. When he left for a job in Manila, the maintenance of the said tricycle reverted
back to me so that all of the papers and documents pertaining thereto were
kept by me;

3. Usually, the sidecar plate number of my tricycle is attached to it in

compliance with the ordinance pertaining to the display of the said plate
number;

4. However, when I sold the side car of my tricycle, I was not able to remove the
plate number, and when I went to the vendee to get the same, it could no
longer be found for some reason or another;

5. Despite diligent efforts exerted by me in locating the same, it proved futile

and unavailing;

6. This Affidavit is being executed to attest to the truth of the foregoing and for
any legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 15th day of

January 2018 at Ocampo, Camarines Sur, Philippines.

NORMA P. IRAULA
Affiant

SUBSCRIBED AND SWORN to before me in accordance with law,

affiant having exhibited to me her Senior Citizen's ID to my full and entire
satisfaction, this 15th day of January 2018 at Ocampo, Camarines Sur,
Philippines.

NOTARY PUBLIC

Doc. No. ______

Page No. ______
Book No. ______
Series of 2017