Form No.13--Affidavit of Loss LTO License Plate

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• Category: Philippines Legal Form
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(Affidavit of Loss LTO License Plate)

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:

Make:_____________
Motor No.:_____________
Chassis No.:_____________
Plate No.:_____________

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.

Affiant

(JURAT)