REPUBLIC OF THE PHILIPPINES)

CABANATUAN CITY
) S.S.
x----------------------------x
AFFIDAVIT OF LOSS
MOTOR VEHICLE CERTIFICATE OF REGISTRATION (CR)
I, HONORIO N. ALIGA, of legal age, Filipino, married and a resident of Poblacion West IV
Aliaga, Nueva Ecija, after having been duly sworn to in accordance with law, depose and
state THAT:
1. I am the registered owner of a motor vehicle which is particularly described as follows:
Make & Type : Kawasaki CT100
Motor Number : DUEBNH55395
Chassis Number : MD2DDDUZZNWH06010
Plate Number : 5134CC
MV File No. : 0368-00000010835
Year Model/Color : 2007/Red
2. As proof of ownership of the above-described vehicle I was issued by the Land Transportation
Office, Certificate of Registration (CR);
3. The said documents while in my possession were misplaced and could no longer be located in
spite of diligent efforts to locate them;
4. Said documents were neither transferred to other persons/entity/financial institutions for any
consideration nor encumbered to guarantee financial obligations with any financial
institution;
5. Said documents were not confiscated by any government authorities for violation of R.A.
4136 and other related laws;
6. I shall assume responsibility or liability if in any event I will use these documents for
whatever illicit transactions;
7. I am executing this affidavit to attest to the veracity of my statements and to support my
request for duplicate copies of the lost CR with the Land Transportation Office (LTO).
IN
WITNESS
WHEREOF,
I
have
hereunto
set
this ___________________ in Cabanatuan City, Nueva Ecija, Philippines.

my

hand

____________________
Affiant

SUBCRIBED AND SWORN TO before me this ___________________ in Cabanatuan

City, Nueva Ecija, , Philippines.
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2016.