REPUBLIC OF THE PHILIPPINES )

PROVINCE OF SULTAN KUDARAT) S.S.

MUNICIPALITY OF ISULAN )
X- - - - - - - - - - - - - - - - - -- - - - - - - - -X

AFFIDAVIT OF LOSS

I, BENJAMIN C. TAN, of legal age, Filipino, married and a resident of

Bajada, Davao City, after having been duly sworn to in accordance with law do
hereby depose and say:

1. That I am the holder of Original copy of Official Receipt (OR) and Certificate
of Registration (CR) and registered owner of motor vehicle particularly
describe as follow;

MAKE/BODY-----------------------------------------NISSAN/SUV
SERIAL/CHASISS NO.------------------------------WBYD21045821
ENGINE NO.------------------------------------------TD27048675T
PLATE NO.--------------------------------------------XDJ364
COLOR------------------------------------------------BROWN/GREEN

2. That sometime on April 2017, I discovered that the said original copy of
Official Receipt (OR) and Certificate of Registration (CR) were
lost/misplaced by me;

3. That I diligently searched and look for the said original copy of Official
Receipt (OR) and Certificate of Registration (CR) but I could no longer
locate the same;

4. That I execute this affidavit to establish and declare the fact of the loss of
the said Drivers License Card and for whatever purpose this affidavit may
serve best.

IN WITNESS WHEREOF, I have hereunto set my hand this __ day

of_______________,______________ at Isulan, Sultan Kudarat, Philippines.

BENJAMIN C. TAN
Affiant
___________________

SUBSCRIBED AND SWORN to before me this __ day of

____________________,_____________ at Isulan, Sultan Kudarat, Philippines.
REPUBLIC OF THE PHLILIPPINES )
PROVINCE OF SULTAN KUDARAT ) S.S.
MUNICIPALITY OF ISULAN )
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AFFIDAVIT OF CHANGE COLOR OF

MOTOR VEHICLE

I, BENJAMIN C. TAN, of legal age, Filipino, married and a resident of Bajada, Davao City,
after having been duly sworn to in accordance with law do hereby depose and say:

1. That I am the registered owner and possessor of a motor vehicle particularly described
as:

MAKE/BODY-----------------------------------------NISSAN/SUV
SERIAL/CHASISS NO.------------------------------WBYD21045821
ENGINE NO.------------------------------------------TD27048675T
PLATE NO.--------------------------------------------XDJ364
COLOR------------------------------------------------BROWN/GREEN

That I caused the change color of the above-described motor vehicle from BROWN
GREEN to WHITE.

2. That I execute this affidavit to attest to the truth of the above facts and circumstances
and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this __ day of

_______________________,__________________ at Isulan, Sultan Kudarat.

BENJAMIN C. TAN
Affiant
____________________________

SUBSCRIBED AND SWORN to before me this __ day of ______________________,

______________________ at Isulan, Sultan Kudarat.