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Affidavit of Loss ORCR Vehicle - Template

The document is an affidavit of loss filed with the Land Transportation Office in the Philippines. It states that the individual owned a vehicle and was issued an Official Receipt and Certificate of Registration as proof, but those documents were misplaced despite efforts to find them. The individual swears the documents were not transferred, encumbered, or confiscated by authorities. They take responsibility if the documents are used for illicit purposes and request duplicate copies from the LTO to replace the lost documents.

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632 views1 page

Affidavit of Loss ORCR Vehicle - Template

The document is an affidavit of loss filed with the Land Transportation Office in the Philippines. It states that the individual owned a vehicle and was issued an Official Receipt and Certificate of Registration as proof, but those documents were misplaced despite efforts to find them. The individual swears the documents were not transferred, encumbered, or confiscated by authorities. They take responsibility if the documents are used for illicit purposes and request duplicate copies from the LTO to replace the lost documents.

Uploaded by

lr biz
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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REPUBLIC OF THE PHILIPPINES)

CITY OF SAN FERNANDO, PAMPANGA) S.S.


x----------------------------x

AFFIDAVIT OF LOSS OR/CR

I, ___________________, of legal age, Filipino, (single/married/widow) and


a resident of _______________________________, after having been duly
sworn to in accordance with law, depose and state THAT:

1. I am the registered owner of a motor vehicle which is particularly described as


follows:

Make & Type : ______________


Motor Number : ______________
Chassis Number : ____________
Plate Number : ______________
MV File No. : ________________
Year Model/Color : ___________

2. As proof of ownership of the above-described vehicle I was issued by the Land


Transportation Office, Official Receipt (OR) and Certificate of Registration (CR);

3. The said documents while in my possession were misplaced and could no longer
be located in spite of diligent efforts to locate them;

4. Said documents were neither transferred to other persons/entity/financial


institutions for any consideration nor encumbered to guarantee financial
obligations with any financial institution;

5. Said documents were not confiscated by any government authorities for


violation of R.A. 4136 and other related laws;

6. I shall assume responsibility or liability if in any event I will use these


documents for whatever illicit transactions;

7. I am executing this affidavit to attest to the veracity of my statements and to


support my request for duplicate copies of the lost MVRR/MVMRR/OR/CR with
the Land Transportation Office (LTO).

IN WITNESS WHEREOF, I have hereunto set my hand


this ___________________ in City of San Fernando, Pampanga, Philippines.

SUBCRIBED AND SWORN TO before me this ___________________ in


_________________, Philippines, affiant exhibiting to me his/her competent
evidence of identity by way of __________________ issued at
______________ on __________________.

Doc. No. _____;


Page No. _____;
Book No. _____;
Series of _____

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