Republic of the Philippines )

Province of La Union )S.S.

Municipality of Naguilian )
x----------------- --x

AFFIDAVIT OF LOSS
I, ROGIN ABENES, of legal age, Filipino, single and a resident of Brgy. Guesset,
Naguilian, La Union, Philippines, after being duly sworn to in accordance with law, hereby
depose and state:

1. That I am the authorized driver of a motorcycle owned by JONNAH P. ABENES

more particularly described as follows:

Make: Honda Plate No. 7889AC

Model: 2007

2. That the above-mentioned motor vehicle was duly registered with the Land
Transportation Office and I was issued its corresponding Official Receipt (O.R.)
and Certificate of Registration (C.R.);

3. That on March 2, 2017, I placed said Certificate of Registration (C.R.) inside the
tricycle and when I tried to look for said Certificate of Registration (C.R.) for
reference purposes, I found out that it was no longer there where I kept it and
was missing;

4. That I diligently searched for said Certificate of Registration (C.R.) in all areas of
the tricycle and within the premises but the same served futile, and as all
efforts to find the same proved unrewarding, it is now safe to conclude that
recovery of the same is an impossibility;

5. As such, I am executing this Affidavit of Loss to attest to the truth of the

foregoing statement, to support my application for the issuance of said
Certificate of Registration (C.R.) in lieu of the one that was lost and for any
other legal purposes that this affidavit may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 7 th day of March 2017
at Naguilian, La Union, Philippines.

ROGIN ABENES
Affiant

SUBSCRIBED AND SWORN to before me this 7th day of March 2017 at Naguilian,
La Union, Philippines.

ATTY. LOVELLA MAY B. HULIGANGA

Notary Public until December 31, 2018
2nd floor, GACP Arcade Bldg., Ortiz,
Naguilian, La Union
Roll No. 62463; 04.29.13
IBP No. 1043135; 01.03.17
PTR No. 1730852; 01.03.17; La Union
MCLE Compliance No. V-0002517; 05.29.14
TIN No. 255-518-493

Doc. No. _______

Page No. ______
Book No. _______
Series of 2017