Affidavit of Loss

AFFIDAVIT OF LOSS

I,ELY D. NAWAWALAN,of legal age, Filipino, married, and a resident of 555 Sardinas St., Teachers Village, UP Diliman, Quezon City, after having been duly sworn on oath in accordance with law hereby duly sworn on oath in accordance with law hereby voluntary depose and say:
1. I work as a messenger and collector of ASENSADO-UMAASENSO AGGREGATES CORPORATION (AUAC) with office and postal address of 245 D Fatima San Miguel Village Makati City;
2. As a messenger and collector, my employer, assigned to me a motorcycle owned by Mr. Manuel C. Asendsado for my transportation described to wit:
Make: Grandstar Series: LONCIN
Year Model: 2004 Piston displacement: 100
Engine No. LC161FMJA 0251714 Fuel: Gas
Chassis No. LLCLPS 10421093517
Plate Number: FP7307 MV File No. 1391-00000024529
3. On 22 April 2005, at 1:00 p.m. more or less, I went to Unilane Grocery along Kalayaan Avenue, Quezon City, to buy some merchandise;
4. I brought with me the above described motorcycle for my ride. Thereafter, I returned to office;
5. On or about 5:00 p.m. of the same date, I noticed that the plate number of the above described motorcycle was missing;
6. I tried to locate said plate number, but despite diligent effort to recover the plate number, my effort proved futile;
7. I am executing this statement to attest to all the above facts, and to substantiate my application for a new Plate Number.
IN WITNESS WHEREOF,I have hereunto affixed my signature this ______day of ______in Quezon City.

ELY D. NAWAWALAN

Affiant

JURAT

SUBSCRIBED AND SWORNto before me, in the City/Municipality of ______, Province of ______, this ____ day of ______, 2005, affiant exhibiting to me hisDriver's License No. N25-02-003180expiring onMarch 4, 2006.

Name: ______

Notary Public for [Municipality/City/Province]

Office Address of Notary Public _____

Appointment No. _____ Until [date][year]

Roll of Attorneys No. _____

PTR No. ______; [date issued][place issued]

IBP No. ______; [date issued][Chapter]

Doc. No. ____;
Page No. ____;
Book No. ____;
Series of 20__