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Affidavit of Loss

This affidavit details the loss of vehicle license plates from a vehicle owned by the affiant. It states that the vehicle was properly parked and the plates were missing upon return. The affiant swears to surrender the plates if recovered and accepts penalties for unauthorized use if found responsible despite reporting the plates as lost. The purpose of the affidavit is to request replacement plates or permit plate substitution or sale/transfer of the vehicle.

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Ian Khay Castro
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© Attribution Non-Commercial (BY-NC)
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436 views

Affidavit of Loss

This affidavit details the loss of vehicle license plates from a vehicle owned by the affiant. It states that the vehicle was properly parked and the plates were missing upon return. The affiant swears to surrender the plates if recovered and accepts penalties for unauthorized use if found responsible despite reporting the plates as lost. The purpose of the affidavit is to request replacement plates or permit plate substitution or sale/transfer of the vehicle.

Uploaded by

Ian Khay Castro
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PDF, TXT or read online on Scribd
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REPUBLIC OF THE PHILIPPINES) QUEZON CITY )S.S. AFFIDAVIT OF LOSS 1.

_________________________, of legal age, Filipino and a resident of ____________________________________________________,after being sworn to in accordance with law, hereby depose and say, THAT: 2. I am registered owner /operator of the motor vehicle described as follows: Make/Type : ___________ Motor No. : ___________ Chasis No. : ___________ Plate No. : ___________ Trade Name Position of Affiant C.R. No. : __________ Current O.R. No.: __________ File No. : __________ Classification : __________ : ________________ : / / Chairman / / General Manager / / President / / Owner

2. On or about ___ A.M./P.M. of __________, my vehicle was properly parked at _________________. When I returned to retrieve the above-described vehicle on ____________ I noticed that one/both of its plates is/are missing. 3. I lost no time in diligently trying to locate the said plate/s but all efforts exerted proved futile and no to avail, and that the same is considered lost or stolen and beyond recovery; 4. The said lost plate/s was/were never lent to another person or entity nor confiscated by any other law enforcement agency; 5. I bind my self to surrender the said plates to the district office that issued the same in the event that said plates are recovered; 6. If the DOTC thru the LTO/LTFRB, after inquiry, has found me responsible for the unauthorized use of the herein reported lost plates, hereby signify my conformity to be meted the administrative fines and penalties due and imposed thereon, including the ground of the unit/s covered by the Certificate of Public Convenience issued thereof, with waiver and distance on my part for any claim or action by reason of the aforesaid punitive measures taken against me. 8. Purpose of this Affidavit of Loss: /_/ For LTFRB Petition for Dropping and Substitution /_/ For LTFRB Petition for Sale and Transfer, and/or /_/ For securing a replacement for lost plates 8. I am executing this affidavit for the aforesaid purpose/s as well as for attesting to the truth of the statements herein declared, subject to the rules on perjury. AFFIANT FURTHER SAYETH NAUGHT. _______________________ Affiant Com. Tax Cert. No._______ Issued at ______on_______ SUBSCRIBED and SWORN to before me this ____day of ________ 2004 at Quezon City, affiant exhibited to me his/her, community tax certificate.

Doc. No.______ Book No.___ Page No._____ Series of 2000

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