Republic of the Philippines )
C I T Y O F D I P O L O G ) S.S.
x-----------------------------------/
AFFIDAVIT OF LOSS
I, EDNA J. CASTILLON, Filipino, of legal age, married, and a resident of Olingan, Dipolog City,
under oath, hereby deposeth and sayeth:
That I had been in possession of a Certificate of Registration issued in the my name by the Land
Transportation, Dipolog City District Office, over the motorcycle which is described as follows:
Make : SUZUKI
Type of Body : CAB. V. DEL
Serial/Chassis No. : DA71T-131416
Motor No. : 5525843
Plate No. : JBD-255
Year Model : 2001
That said Certificate of Registration was never confiscated by any person in authority for
violation of any traffic rules and regulations;
That just recently, I noticed that the said Certificate of Registration was lost;
That despite earnest efforts exerted by me, the same could no longer be found nor recovered;
That I am executing this affidavit in good faith and in accordance with law, to attest to the fact of
the loss of the said Certificate of Registration.
IN WITNESS WHEREOF, I have hereunto affixed my signature this 2 nd day of April, 2013, at
Dipolog City, Philippines.
EDNA J. CASTILLON
Affiant
Witnesses: _______________________ __________________________
SUBSCRIBED AND SWORN to before me this 2 nd day of April, 2013, at Dipolog City, Philippines,
affiant identified thru her Social Security System ID Card No. 10-0565870-2, which bears her photograph
and signature, and who avowed under penalty of law to the whole truth of the contents of the
instrument or document, and that she has executed the same freely and voluntarily.
Doc. No. _________: PETER Y. CO
Page No. _________: Notary Public
Book No. _________: Cities of Dipolog,Dapitan & Province of Zambo. Norte
Series of 2013. Until December 31, 2014
PTR No. 577101 01-03-2013 Dip. City
IBP Lifetime No. 06894 07-18-2006
Roll No. 35379 May 30, 1988
MCLE 3rd Compliance No. III-0001592 12-31-2008
MCLE 4th Compliance No. IV-0000440 05-30-2012
CT No. 35216998 01-03-2013 Barra, Dipolog City
Republic of the Philippines )
C I T Y O F D I P O L O G ) S.S.
x-----------------------------------/
AFFIDAVIT OF LOSS
I, JOSEPH LACAYA LORION, Filipino, of legal age, married, and a resident of Gulayon, Dipolog
City, under oath, hereby deposeth and sayeth:
That pursuant to a document of sale, I had been in possession of a Certificate of Registration
issued in the name of JOSEPH LACAYA LORION by the Land Transportation, Sindangan, Zamboanga del
Norte, over the motorcycle which is described as follows: YAMAHA DT; Engine No.4AR - 068642; Chassis
No. 4AR- 068642; Plate No. JN4739 and a 2007 Official Receipt;
That said Certificate of Registration and 2007 Official Receipt were never confiscated by any
person in authority for violation of any traffic rules and regulations;
That just recently, I noticed that the said Certificate of Registration and 2007 Official Receipt
were lost;
That despite earnest efforts exerted by me, the same could no longer be found nor recovered;
That I am executing this affidavit in good faith and in accordance with law, to attest to the fact of
the loss of the said Certificate of Registration and 2007 Official Receipt.
IN WITNESS WHEREOF, I have hereunto affixed my signature this 25 th day of March, 2013, at
Dipolog City, Philippines.
JOSEPH LACAYA LORION
Affiant
Witnesses: _______________________ __________________________
SUBSCRIBED AND SWORN to before me this 25 th day of March, 2013, at Dipolog City,
Philippines, affiant identified thru his Professional Driver’s License No. JOI-75-007449, expires on
October 12, 2015 which bears his photograph and signature, and who avowed under penalty of law
to the whole truth of the contents of the instrument or document, and that he has executed the same
freely and voluntarily.
Doc. No. _________: PETER Y. CO
Page No. _________: Notary Public
Book No. _________: Cities of Dipolog,Dapitan & Province of Zambo. Norte
Series of 2013. Until December 31, 2014
PTR No. 577101 01-03-2013 Dip. City
IBP Lifetime No. 06894 07-18-2006
Roll No. 35379 May 30, 1988
MCLE 3rd Compliance No. III-0001592 12-31-2008
MCLE 4th Compliance No. IV-0000440 05-30-2012
CT No. 35216998 01-03-2013 Barra, Dipolog City
Republic of the Philippines )
C I T Y O F D I P O L O G ) S.S.
x-----------------------------------/
AFFIDAVIT OF LOSS
I, EDNA J. CASTILLON, Filipino, of legal age, married, and a resident of Olingan, Dipolog City,
under oath, hereby deposeth and sayeth:
That pursuant to a document of sale, I had been in possession of a Certificate of Registration
issued in the name of JOSEPH LACAYA LORION by the Land Transportation, Sindangan, Zamboanga del
Norte, over the motorcycle which is described as follows: YAMAHA DT; Engine No.4AR - 068642; Chassis
No. 4AR- 068642; Plate No. JN4739 and a 2007 Official Receipt;
That said Certificate of Registration and 2007 Official Receipt were never confiscated by any
person in authority for violation of any traffic rules and regulations;
That just recently, I noticed that the said Certificate of Registration and 2007 Official Receipt
were lost;
That despite earnest efforts exerted by me, the same could no longer be found nor recovered;
That I am executing this affidavit in good faith and in accordance with law, to attest to the fact of
the loss of the said Certificate of Registration and 2007 Official Receipt.
IN WITNESS WHEREOF, I have hereunto affixed my signature this 25 th day of March, 2013, at
Dipolog City, Philippines.
JOSEPH LACAYA LORION
Affiant
Witnesses: _______________________ __________________________
SUBSCRIBED AND SWORN to before me this 25 th day of March, 2013, at Dipolog City,
Philippines, affiant identified thru his Professional Driver’s License No. JOI-75-007449, expires on
October 12, 2015 which bears his photograph and signature, and who avowed under penalty of law
to the whole truth of the contents of the instrument or document, and that he has executed the same
freely and voluntarily.
Doc. No. _________: PETER Y. CO
Page No. _________: Notary Public
Book No. _________: Cities of Dipolog,Dapitan & Province of Zambo. Norte
Series of 2013. Until December 31, 2014
PTR No. 577101 01-03-2013 Dip. City
IBP Lifetime No. 06894 07-18-2006
Roll No. 35379 May 30, 1988
MCLE 3rd Compliance No. III-0001592 12-31-2008
MCLE 4th Compliance No. IV-0000440 05-30-2012
CT No. 35216998 01-03-2013 Barra, Dipolog City
