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Affidavit of Loss or CR

The affiant, Rosinee Cagurin-Monte, owns a motor vehicle registered in Dipolog City, Philippines. She was issued a Certificate of Registration and Original Receipt for 2018, but has since lost these documents and is unable to locate them. She is executing this Affidavit of Loss to attest that the documents are lost beyond recovery and to support her application for new registration documents to replace the lost ones.

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Jubelee Anne Patangan
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758 views2 pages

Affidavit of Loss or CR

The affiant, Rosinee Cagurin-Monte, owns a motor vehicle registered in Dipolog City, Philippines. She was issued a Certificate of Registration and Original Receipt for 2018, but has since lost these documents and is unable to locate them. She is executing this Affidavit of Loss to attest that the documents are lost beyond recovery and to support her application for new registration documents to replace the lost ones.

Uploaded by

Jubelee Anne Patangan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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AFFIDAVIT OF LOSS

Republic of the Philippines )


City of Dipolog ) S.S
x-----------------------------------x

I, ROSINEE CAGURIN-MONTE, of legal, Filipino, married and a resident of Lower Dicayas


,Dipolog City, Zamboanga del Norte, after having duly sworn in accordance with law, do hereby depose
and state that:
That I am the owner of a certain motor vehicle, which is more particularly described as follows:

That as a registered owner, I was issued a Certificate of Registration (CR) and an Original Receipt
(OR) for my registration for the year 2018 by the Land Transportation Office of Dipolog City,
Philippines;
That when I was about to register the said motor vehicle for year 2018, I could no longer find the same
such that I 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 my
application for the issuance of New Certificate of Registration and Original Receipt, in lieu of the ones
that were lost.

IN WITNESS WHEREOF, I have hereunto affixed my hand this ___________ day of


____________ at Dipolog City.

ROSINEE CAGURIN-MONTE
AFFIANT
PRC ID No.

SUBSCRIBE AND SWORN TO before me this _____________ at Dipolog City.

Doc. No.____
Page No.____
Book No.____
Series of 2018

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