Republic of the Philippines}

C I T Y O F D I G O S} SS.
x- - - - - - - - - - - - - - - - x

AFFIDAVIT OF LOSS

I, RHEA OLAIVAR of legal age, single, and a resident of

No. 1996, S.D.A Road, Digos city after being sworn in
accordance with law, depose and state that:

That I am the registered owner of a certain motor

vehicle, which is more particularly described as follows:

Make: Honda fit

Series: 2010
Type of Body: small
Motor No. S123124
Chassis No. C1947231
Yr. Model 2010 Model
Color: Pink
Plate No. OMW 1234

That as a registered owner, I was issued a

Certificate of Registration (C.R.) and an Original Receipt
(O.R.) for my registration for the year 2016 by the Land
Transportation Office o Digos City, Philippines;
That when I was about to register the said motor vehicle for
year 2017, I could no longer find said
Certificate of Registration and Official Receipt of the said
motor vehicle.
That despite diligent search and efforts to locate the said
documents, 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 set my hand

this 9th day of January 2017, in the City of Digos, Philippines.

RHEA OLAIVAR
Affia
nt

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 SUBSCRIBED AND SWORN to before me, in the City
of Digos, this 9th day of January, 2017 by affiant with Tax
Identification No. 808-467-832.

JAMES L. DECOLONGON
Notary Public
Doc No. ____ Until December 31, 2017
Page No. ____ Roll No.: 82714
Book No. ____ IBP No. 631820, January 6, 2014, Digos
City
Series of 2017 PTR No.080324 January 6, 2014 Digos
City TIN: 290-937-407 January
6, 2010 Digos City

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