Republic of the Philippines)
Province of ____________________) S.S.
City/Municipality of _____________)
x – – – – – – – – – x
AFFIDAVIT OF LOSS
I, _____________, Filipino, of legal age, (single / married / widow), and a resident of _____________, Philippines, after being duly sworn in accordance with law, depose and state:
That I am the registered owner of a certain motor vehicle, more particularly described as follows:
That on or about _____________, the front license plate of the said vehicle was lost;
That despite diligent search and efforts to locate the said license plate, I could not find the same such that I now believe that they are now lost beyond recovery.
As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing and to support the application for the issuance of a new one in lieu of the one that was lost.
IN WITNESS WHEREOF, I have hereunto set my hand this _____________ at _____________, Philippines.