REPUBLIC OF THE PHILIPPINES )
CITY OF VALENZUELA
) SS.
AFFIDAVIT OF LOSS
I, JAHZEL D. CARPIO, Filipino, of legal age, single, and a resident of #
4026 Grapes St., Bernardino Subdivision, Gen. T. De Leon, Valenzuela
City, after having been duly sworn in accordance with law, hereby depose and
say:
1. That I am a holder of a school identification card bearing serial
number 0810275 issued by New Era University;
2. That I used to put said identification card in my pouch, among others;
3. That sometime on November 16, 2015, I was in hurry to my room
and got too much things carried, I put my ID in the paper bag of snacks I
bought.
4. That I honestly forgotten and mistakenly throw it with the paper bag.
5. That diligent search of said school ID card proved futile and
unavailing;
6. That said school ID card was not confiscated by the authorities of New
Era University by reason of any violation of school rules and regulations;
7. That I am executing this affidavit to attest to the truth of the foregoing
facts and to request for a replacement of said school ID card from New Era
University.
FURTHER, I SAYETH NAUGHT
IN WITNESS WHEREOF, I have hereunto affixed my signature this ____
day of January 2016 at Valenzuela City, Philippines.
Jahzel D. Carpio
Affiant
SUBSCRIBED AND SWORN TO before me, a notary public in and for
JAHZEL D. CARPIO this _____ day of January 2016. The affiant, whom I
identified through the following competent evidence of identity: License ID NO.
N25-15-026922, issued by Commission on Elections, personally signed the
foregoing instrument before me and avowed under penalty of law to the whole
truth of the contents of said instrument.
Doc. No. ______;
Page No. ______;
Book No. ______;
Series of ______.
REPUBLIC OF THE PHILIPPINES )
CITY OF VALENZUELA
) SS.
AFFIDAVIT OF LOSS
I, JAHZEL D. CARPIO, Filipino, of legal age, residing at # 4026 Grapes
St., Bernardino Subdv., Gen. T. De Leon, Valenzuela City, after having been
sworn in accordance with law hereby depose and state:
That I am the true and lawful owner of a certain motor vehicle which is
more particularly described as follows
MAKE:
TOYOTA TOWN
ACE
TYPE OF BODY : VAN
MOTOR NO. : 3C3380165
SERIAL/CHASSIS NO. :
CR400002848
PLATE NO. :
RCC654
FILE NO. :
0386-00000095960
That unfortunately, on August 7, 2012, I lost the original Certificate of
Registration of my car when the same was destroyed by flood due to Habagat;
avail;
That I took pains to look for said Certificate of Registration, but to no
That I am executing this affidavit to attest to the truth of the foregoing
and to request from the Land Transportation Office of Valenzuela City, a copy of
said Certificate of Registration.
FURTHER, I SAYETH NAUGHT
IN WITNESS WHEREOF, I have hereunto set my hand this 25th day of
January, 2013 at Valenzuela City.
Jahzel D. Carpio
Affiant
SUBSCRIBED AND SWORN to before me, this 25 th day of January,
2013 in City, who satisfactorily proven her identity to me through her CTC No.
24871383, issued on March 25, 2006 at Valenzuela City, that she is the same
person who personally signed the foregoing affidavit before me and
acknowledged that he executed the same.
Doc. No. 167;
Page No. 25;
Book No. XIII;
Series of 2013.
NOTARY PUBLIC
Until December 31, 2014
PTR No . 1228734
Valenzuela City . January 3, 2013
Roll No. 23233 . May 27, 2001
ATTY. PABLITO CANDIDO
IBP Lifetime No . 03627. CALMANA
