Republic of the Philippines )

PROVINCE OF MASBATE )
City of Masbate )
X-------------------------------------------X

AFFIDAVIT OF LOSS

I, JENNIFER RAMIREZ, of legal age, married, resident of Purok 7, Barangay F.

Magallanes, after having duly sworn to, in accordance with law herby depose and say:

That I am the registered owner of a motorcycle, make Kawasaki, Bajan series

CT100s, with Certificates of Registration No. 206370312, dated March 20, 2015;

That sometime on March 2017, I renewed the registration of said Motorcycle at

LTO Masbate field office.

That upon scrunching of my own personal files of said motorcycle I found out that
the original copy of official receipt of the newly registration records were missing,

That I exerted all efforts to retrieve and locate the same but resulted futile and to
no avail.

That I am executing this affidavit of loss to attest that foregoing is true and
correct to the best of knowledge.

IN TRUTH OF THE ABOVE, I have hereunto affix my signature this 14th day of
February 2018, at Masbate City Philippines.

____________________
JENNIFER M. RAMIREZ
Affiant

SUBSCRIBED AND SWORN to before me this _______ day of February 2018,

at Masbate City Philippines