Republic of the Philippines - - - -)Sc.

City of Bacolod - - - - - - - - - - -)
x-----------------------------------x

AFFIDAVIT OF LOSS

I, ROLANDO A. APELLIDO, of legal age, married, Filipino, and a
resident of Barangay 69, Bacolod City, after being sworn to in accordance
with law, hereby depose and say that:

1. I am the owner of a Honda Civic sedan with Plate No.
FFU556, Motor No. MX125AEO63719 and Serial/Chassis No.
MX125A-BO8549;

2. The Certificate of Registration for said vehicle was
issued to me by the Land Transportation Office in Bacolod City a
long time ago;

3. However, last November 8, 2013, the certificate of
registration was damaged and destroyed when Typhoon Yolanda
hit the province of Negros Occidental alongside the provinces of
Leyte, Bohol, Cebu, Negros Oriental as well as the city of Iloilo;

4. Despite diligent efforts to recover said Certificate of
Registration, it could no longer be recovered and as such, the
same must be deemed lost or destroyed for all legal intents and
purposes;

5. I am now executing the foregoing affidavit in order
to attest to the truthfulness of the foregoing facts, to comply
with the requirements for the re-issuance of the said Certificate
of Registration with the Land Transportation Office in lieu of the
one which was lost, and for whatever legal purposes this
affidavit may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this December
14, 2013, in Bacolod City, Philippines.


_______________________
ROLANDO A. APELLIDO
SSS ID No. 1239874


SUBSCRIBED AND SWORN TO before me this 14 December 2013, in
the City of Bacolod, Philippines, Affiant appeared to me and shown his Social
Security Identification Card as noted above.

Witness my hand and seal.


Doc. No. ___;
Page No. ___;
Book No. ___;
Series of 2013.