Republic Of the Philippines)

Santa Cruz, Laguna

) ss.
AFFIDAVIT OF DAMAGED/DESTROYED
LICENSE PLATE OF MOTORVEHICLE
We, CESAR V. RIZALDO and LORETA SANDICHO, Filipino citizens, of legal age and
residents of Brgy. Palasan, Santa Cruz, Laguna after having been sworn in accordance with
law hereby depose and state:
That we are the lawful owners of a certain motor vehicle described as follows:
Motorvehicle Information
Make/Type
ISUZU Jitney
Year Model
1991
Engine Number
141655
Chassis Number
SPMM-46809-91C
Plate Number
DJJ-368
MV-File Number
0476-5B-28888-91
Classification/Fuel
Private / Diesel
That over the years, the license plate number at the back of the vehicle was gradually
and continuously damaged and destroyed by rust and other natural elements which now
eventually rendered it no longer fit for further use in operating the vehicle. Thus, there is a
need to replace the said License Plate numbered DJJ-368 by the Land Transportation Office
(LTO). Copy of the damaged and destroyed license plate is hereto attached for immediate
reference.
That I am executing this affidavit to attest to the truth of the foregoing and to request
the LTO-Pila, Laguna District Office for issuance of a new License Plate No. DUJ-368 to
replace the old plate which was badly damaged/destroyed/dilapidated.
IN WITNESS WHEREOF, we hereto affixed our signatures this 31 July 2013 in Santa
Cruz, Laguna. _________________________.

CESAR V. RIZALDO
Affiant

LORETA SANDICHO
Affiant

SUBSCRIBED AND SWORN to before me, by the following affiants who exhibited their
respective proof of identification, hereunder specified, to wit:
Cesar V. Rizaldo with ________________I.D. No. ______________
issued at ________________ on _____________; and
Loreta Sandicho with ________________I.D. No. ______________
issued at ________________ on ______________.
WITNESS MY HAND AND NOTARIAL SEAL, this 31 July 2013 in Santa Cruz, Laguna.

Doc. No. _______;

Page No. _______;
Book No. _______;
Series of 2013.

ATTY. EMMANUEL E. SANDICHO

NOTARY PUBLIC UNTIL 31 DECEMBER 2014
IBP No. 905396, 02 January 2013, Laguna
PTR No. 534868, 02January 2013, Laguna
Roll No. 42246, admitted on 09 May 1997
MCLE Compliance Period No. IV-00012117