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REPUBLIC OF THE PHILIPPINES)

CITY OF ___________ ) S.S.


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

AFFIDAVIT OF LOSS

I, ____________________________, Filipino, of legal age, single, and a resident


___________________________________, Philippines, after being duly sworn in
accordance with law, depose and state:

1. That I am the bona-fide holder of BIR Tax Identification Number (ID) card;

2. That being issued by the Bureau of Internal Revenue, and has been registered with
BIR TIN ___________________________;

3. That sometime in ________________________, the original copy of the said BIR


Tax Identification Number (ID) card could not be found and that despite of diligent
search and efforts, the same could no longer be found such that I now believe that
it is now lost beyond recovery.

4. As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing
and for whatever legal purposes that this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ________________ at


______________________, Philippines.

AFFIANT

SUBSCRIBED AND SWORN to before me, this ______________________, by the


Affiant who is personally known to me or whom I have identified through competent evidence of
identity and who exhibited _________________________ issued at _______________________.

NOTARY PUBLIC
Doc. No. ______;
Page No. ______;
Book No.______;
Series of 2019.