September
10, 2018
AFFIDAVIT OF LOSS
TO WHOM IT MAY
CONCERN:
That I, ALONA D. CADAG, of legal age, Filipino, Single/Married, and with residence at Blk. 7, Lot 5, Rafeli St., Chateau Ville Subd., after having sworn to in accordance with law do hereby depose and say;
That I am the absolute owner of the
following motor vehicle by virtue of Deed of Sale duly notarized dated
September 7, 2018 more particularly described as follows:
MAKE/TYPE : NISSAN
URVAN/VAN
MODEL : 2005
ENGINE NO. : TD2Y-753945
CHASSIS NO. : TVP4LEFE24-A28874
PLATE NO. : XTX-379
As proof of ownership of the above-described Motor Vehicle i was issued a Certificate of Registration No. 65452xxx-xand Official Receipt No, 45825xxxxx by the Land Transportation Office Lipa City District R4A.
That the following documents were
lost inside the motor vehicle were I am
riding on way to Makati sometime on September 10, 2018;
1. Orig.
CR/OR of the motor vehicle duly registered in favor of NOTRE DAME DE VIE
INSTITUTE of Bo. San Agustin Novaliches Proper Q.C.
2. Orig.
Deed of Sale duly notarized from NOTRE DAME DE VIE INSTITUTE (VENDOR) with Secretariat
Certificate to JEORGE A. LEONARDO (VENDEE) dated September 6, 2011.
3. Orig.
Deed of Sale duly notarized from GEORGE A. LEONARDO (VENDOR) to ALONA D. CADAG
(VENDEE) dated September 7, 2018.
4. Orig.
Highway Patrol Clearance Transfer of Ownership dated September 7, 2018.
5. Orig.
copy of TPL insurance for LTO copy dated September 7, 2018.
6. Orig.
copy of Emission Test accredited by Manila West LTO District Office.
7. Photo
copy of Identification Card of the following:
a. NOTRE
DAME DE VIE INSTITUTE
b. GEORGE
A. LEONARDO
c. ALONA
D. CADAG
That
the above cited documents were placed in tact in an envelope placed besides me on
board the vehicle bound for Makati. When I alighted the vehicle I forgot to
bring my envelope.
That
I exerted much effort to locate and find the vehicle, I was able to traced the
vehicle but my envelope has gone already missing.
That
I executed this affidavit to attest the truth of the foregoing instrument.
ALONA
D. CADAG
Affiant
REPUBLIC OF
THE PHILIPPINES )
PROVINCE OF
_______________________: S.S.
CITY/MUNICIPALITY_________________)
Before me Notary Public for and the
City/Municipality of ___________________ appeared with Res. Cert. No.
_______________ issued on _________________ at _______________________ known to
me as the same person who executed the foregoing instrument.
WITNESS MY HAND AND SEAL this ______
day of ______________ 2018.
Doc. No.
______
Page No.
______
Book No.______
Series of ______
★★★☆☆☆★★★
Note: All of information's like name, address and other sensitive information are not true and this is for example purposes only.