Republic of the Philippines )

Kawit, Province of Cavite….) Sc.

AFFIDAVIT OF LOSS PLATE

I, HAROLD MELVIN BENDO DE TAZA, Filipino, of legal age, married, with

address at General Trias, Province of Cavite, after having been sworn in
accordance with law hereby depose and state that:

1. That I am a registered owner/ operator of the motor vehicle described as follows, to

wit:

Make/Type: Honda Chassis No.: KB509234736

Motor No: KB509E234743 Plate No.: 4914WR

2. Sometime on January 2020, my plate no. was detached while I am driving in Alfonso,
Cavite;

3. That when I got home, I saw that the plate number of my motor vehicles was
missing from where it was attached;

4. I lost no time in diligently trying to locate that said plate/s but all efforts proved
futile and no to vail. Thus, the said plate may now be considered lost or stolen
beyond recovery;

5. That the said lost plate/s was/were never lent to another person or entity nor
confiscated by any other law enforcement agency;

6. I bind myself to surrender the said plate/s to the district office that issued the same
in the event that the said plates are recovered in due time;

7. If the DOTC, thru the LTO/LTFRB, after inquiry has found the responsible for the
unauthorized use of the herein reported lost plates, I hereby signify my conformity
to be meted the administrative fines and penalties due and imposed thereon
including the grounding of the units covered by Certificate of Public Convenience
issued therefore, with waiver and desistance on my part of any claim or action by
reason of aforesaid punitive measures taken against me;

8. Purpose of this Affidavit of Loss

( )for LTFRB Petition for Dropping and Substitution
( ) for LTFRB Petition Sale and Transfer and/or
(x) for securing replacement for lost Plate/s

9. That I am executing this affidavit aforesaid purpose/s as well as for attesting to the
truth of the statement herein declared, subject to the rules of perjury;

IN WITNESS WHEREOF, I have hereunto affixed my signature hereunder this

28 day of February 2020 at Kawit, Cavite.
th

HAROLD MELVIN BENDO DE TAZA

Affiant

SUBCRIBED AND SWORN to before me this 28th day of February, 2020 at

Kawit, Cavite, affiant exhibiting to me her competent evidence of identity by way
of AFP with no. N18-E-46416 bearing her photograph and signature.
Doc. No. 260.
Page No.53.
Book No. II
Series of 2020