AFFIDAVIT OF LOSS

REPUBLIC OF THE PHILIPPINES) _____________________________ ) S.S. I, (Name of Affiant)., Filipino, of legal age, residing at (Address of Affiant), after having been sworn in accordance with law hereby depose and state: That I am the true and lawful owner of a certain motor vehicle which is more particularly described as follows: MAKE SERIES TYPE OF BODY YEAR MODEL : : : : MOTOR NO. SERIAL/CHASSIS NO. PLATE NO. FILE NO. : : : :

(Change the declaration below to the actual circumstances) That sometime in June of this year, I was looking for the original Certificate of Registration of my car but to my surprise, said Owners original Copy could not found; That I took pains to look for said Certificate of Registration, but to no avail; That I am executing this affidavit to attest to the truth of the foregoing and to request from the Land Transportation Office of Angeles City, a copy of said Certificate of Registration. IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of _______________. 20___ at _________________________.

(Name Over Signature of Affiant) SUBSCRIBED AND SWORN to before me, this ____ day of ______________, 20___ in ___________________ City, with affiant exhibiting his CTC No. _______________ , Issued on ______________________ at _________________________. NOTARY PUBLIC Until December 31, 200___ Doc. No. : ________; Page No. : ________; Book No. : ________; Series of 20___

AFFIDAVIT OF DISCREPANCY

I, JUAN DELA CRUZ, of legal age, married, Filipino and a resident of _____________, Philippines having been duly sworn in accordance with law, hereby depose and state: That on _____________, I was issued a Philippine Passport with passport number _____________ in which my true surname DELA CRUZ was stated; That before the expiration of the aforementioned passport on _____________, I had applied with Philippine Embassy in _____________ for the issuance of a new passport and on _____________, I was issued a new Philippine passport with passport no. _____________; However, in the said new passport my surname had been erroneously misspelled as DELA CRUX; That I execute this Affidavit of Discrepancy to attest to the truth of the foregoing facts and to explain the discrepancy in my Philippine Passport with regards my surname. IN WITNESS WHEREOF, I have hereunto set my hand this _____________, at _____________, Philippines. Affiant

(JURAT)

JURAT SUBSCRIBED AND SWORN to before me, this 15th day of March, 2007 in the City of Quezon, affiant exhibiting before me his Community Tax Certificate No. 123456, issued at Quezon City on March 1, 2007. ATTY. JANE ABLAZA NOTARY PUBLIC for Quezon City 15 Carnation St., DRJVillage, Novaliches, Q.C. Until Dec. 31, 2007 Roll No. 0001 P.T.R. No. 0002, 12/31/2007, Manila. IBP No. 0003, 12/31/2007, Manila. MCLE Compliance No. 1234 Serial No. of Commission: 07-11111 Doc. No. 5; Page No. 6; Book No. I; Series of 2007.