(Affidavit of Loss LTO License Plate)

Republic of the Philippines)

Province of ____________________) S.S.
City/Municipality of _____________)
x---------x
AFFIDAVIT OF LOSS
I, _____________, Filipino, of legal age, (single / married / widow), and a
resident of _____________, Philippines, after being duly sworn in
accordance with law, depose and state:
That I am the registered owner of a certain motor vehicle, more particularly
described as follows:
Make:_____________
Motor No.:_____________
Chassis No.:_____________
Plate No.:_____________
That on or about _____________, the front license plate of the said vehicle
was lost;
That despite diligent search and efforts to locate the said license plate, I
could not find the same such that I now believe that they are now lost
beyond recovery.
As such, I am executing this Affidavit of Loss to attest to the truth of the
foregoing and to support the application for the issuance of a new one in
lieu of the one that was lost.
IN WITNESS WHEREOF, I have hereunto set my hand this _____________
at _____________, Philippines.

Affiant
(JURAT)