Republic of the Philippines)

Province of Albay
) S.S.
City of Legazpi)
X------------------ -x

AFFIDAVIT OF LOSS
I, CHERRY B. SANORJO, Filipino, of legal age, married and a
resident of Brgy. Dapdap, Legazpi, Albay, Philippines, after being sworn to in
accordance with law, depose and state:
1. That, I am the lawful owner of a motorcycle described with the
following specifications:
Make:
Isuzu Kawasaki Rouser 200
MV File No: 0524-00000081403
MD2DHJCZZSCD44845
Year Model: 2009

Engine No: JCGBSD74540

Chassis
No:

2. That as proof of said ownership, The Land Transportation Office has

issued under my name a Certificate of Registration with CR No.
9475114-5 on February 18, 2010;
3. That the original copy of said Certificate of Registration was eventually
misplaced and only its photocopy is in my possession, to which I attest
is a faithful reproduction of the original;
4. That the undersigned exerted effort to locate the aforementioned
original Certificate of Registration however the same could not be
found;
5. That I am executing this Affidavit to attest to the truth of the forgoing
for whatever purpose it may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of
________ 2017 in Legazpi City, Philippines.
CHERRY B. SANORJO
AFFIANT
SUBSCRIBED AND SWORN to before me this ______________, Affiant
exhibited to me his ________ ID with ID Number _________issued at _________
on ___________.

NOTARY PUBLIC
Doc. No.____________
Page No.____________
Book No.____________
Series of 2017