Republic of the Philippines )
City of Tacloban ) SS
AFFIDAVIT OF LOSS
I, ZALDY A. MONTE, of legal age, Filipino, single and a resident of Los
Angeles Street, Burauen, Leyte, after having been sworn to according to law,
hereby depose and state: THAT—
1. I am the registered owner of a motor vehicle more particularly
described as follows:
MAKE/ SERIES/ TYPE : TOYOTA/HILUX
TAMARAW/UTILITY
ENGINE NO. : 2GD5691109
CHASSIS NO. : PAHACACA2R6420012
PLATE No. : HAH 6674
Cert. of Registration : 47970061-6
Official Receipt no. : 080125000001490
2. After the purchase of the said motor vehicle the Land
Transportation Office (LTO) issued the corresponding plate number bearing
HAH 6674 where it was installed in said motor vehicle for daily use as per
regulation from LTO;
3. Around 4 January 2025 in the morning, the said motor vehicle was
assigned to my authorized driver, Benedicto P. Acebedo and before using the
same, he inspected the said vehicle complete with plate number and no seen
damage that time, then he together with me used the vehicle to go to
Tacloban Public Market to buy goods, roam around downtown area for some
errands, then went to Sandy Lane in Marasbaras, Tacloban City to fetch
employees of Payapay Seafood Park to be ferried to its office at San Jose,
Tacloban City;
4. When we arrive at Payapay Seafood Park around noon time that
day, he noticed that the front plate number of the aforesaid vehicle is already
missing so we exerted diligent efforts to locate the same within the vicinity of
Payapay Seafood Park, Tacloban Public Market, downtown area and in
Marasbaras, Tacloban City where it could have fell while we were in transit
but unfortunately my efforts proved futile as we could no longer locate the
same hence, we considered the same to have been lost forever and beyond
recovery;
5. I am executing this affidavit to attest to the truth of the loss of said
Plate number HAH 6674 of the above-described motor vehicle for the purpose
of issuance of a new plate number before the LTO and for whatever legal
purpose this may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this
______________ at Tacloban City, Philippines.
ZALDY A. MONTE
Affiant
SUBSCRIBED AND SWORN to before me this _______________ at
Tacloban City, affiant exhibiting to me his DL No. H02-00-050878 as his
competent evidence of identity.
Doc. No.
Page No.
Book No.
SERIES OF 2026