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Aff of Loss LTO Plate Number

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REPUBLIC OF THE PHILIPPINES)

Province of Agusan del Sur ) S.S.


Municipality of Prosperidad )
x-----------------------x

AFFIDAVIT OF LOSS

I, ELEONOR L. DINLAYAN Filipino, of legal age, Midwife II at National


Commission on Indigenous People- Provincial Office, and a resident of Barangay Patin-ay,
Prosperidad, Agusan Del Sur , after having been sworn in accordance with law, hereby
depose and state THAT:

1. I was the focal person and member of PDT for

2. That the aforementioned motorcycle was issued with Plate No. 5582-OY;

3. Sometime in October 2019, while I was driving the said motorcycle somewhere in our
Municipality, the Plate unknowingly detached from its place ;

4. I exercised due diligence in locating the said Plate Number and have reported its loss to the
proper LTO Office, Patin-ay, Prosperidad, Agusan del Sur;

5. My efforts to locate Plate No. 5582-OY failed since until now the same has not been found,
leaving me with no other recourse but to request and process for the issuance of a replacement
thereof, for which purpose this affidavit is executed; and

6. I attest to the truth of the foregoing statements.

IN WITNESS WHEREOF, I hereunto affix my signature this 27th day of November 2019 at Patin-
ay, Prosperidad, Agusan del Sur, Philippines.
 

MA TERESA P. BAYLON
Affiant

SUBSCRIBED AND SWORN to before me, this 27th day of November 2019 at Patin-ay,
Prosperidad, Agusan del Sur, Philippines.

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