AFFIDAVIT OF LOSS OF CERTIFICATE OF OWNERSHIP PAPERS OF AUTOMOBILE

AFFIDAVIT

REPUBLIC OF THE PHILIPPINES   )

PROVINCE OF _______________ )  SS

MUNICIPALITY OF ___________  )

            I, ____________________, of legal age, single/married residing at _____________________--, after being sworn in accordance with law, depose and say:

            That I am the true owner of an automobile, described as follows, to wit:

      (Here, state make, model, motor number, Chassis Serial No. _______; Registration Certificate No. ___________, Plate No.; File No. ______________, etc.)

             That the said automobile had been duly registered in my name in the Motor Vehicle Office in __________ for the year (or years) ____________________________.

              That the certificate of registration and other pertinent papers of ownership of said automobile were among those burned and destroyed on ____________  when my house and all personal belongings were completely destroyed by _____________.

                That said papers are now beyond recovery.

                IN WITNESS WHEREOF, I have hereunto set my hand this _________ day of _____________, 20___, in the Municipality of ___________________, Province of ______________, Philippines.

                                                                                                                  


                                                                                                                ____________________________
                                                                                                                      (Signature of Affiant)

               SUBSCRIBED and sworn to before me, in the city/municipality of __________________, this ___________ day of _________________, 20___________ by ___________________ with Residence Certificate No. ________________ issued at ___________________ on ______________, 20_____.

                                                                                                      

                                                                            NOTARY PUBLIC

                                                                            My commission expires Dec. 31, 20__

                                                                            Not. Reg. No._____________________;

                                                                            Page No.________________________ ;

                                                                            Book ___________________________;

                                                                            Series of 20___________