Download as docx, pdf, or txt
Download as docx, pdf, or txt
You are on page 1of 1

REPUBLIC OF THE PHILIPPINES

CITY OF CALAPAN, PROVINCE OF


ORIENTAL MINDORO

AFFIDAVIT OF LOSS

I, Shyrell Waters, of legal age, Filipino, married and a resident of Corregidor

St. San Vicente West, Calapan City, Oriental Mindoro, after having been duly sworn

to in accordance with law, depose and state:

1. That I am the registered owner of the business Waters Engineering Services and
Trading with the store located at Brgy. Tawiran, Calapan City.

2. That it was registered at BIR Br. 63 and issued official receipts sometime last January
2012.

3. That said business has ceased operation and did not earn any income since October
2012 due to poor business opportunities, as evidenced by the notice of closure and
the Certification issued by the City Government of Calapan.

4. That it was the office staff who managed the closure of the business since I already
moved to Batangas City to pursue my law studies last 2012.

5. That said staff is nowhere to be found and she did not turn over any document related
to my business, including the following:

1. Business Registration
2. BIR Registration
3. Barangay Permits
4. BIR Books and Ledgers
5. Official Receipts/ Sales Invoice
6. Others

4. That diligent effort to locate the same and said staff proved futile;

5. That in view thereof, I now desire and hereby request the Bureau of Internal Revenue
Branch 63, to consider the finality of closure of said business in their System;

6. That I bind myself to save Bureau of Internal Revenue, harmless from any loss or
damage that it may incur in connection with the closure of the said business;

7. That I am executing this affidavit to attest to the foregoing facts and for any legal
purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of January
2018 in Calapan City, Oriental Mindoro, Philippines.

Shyrell Waters
Affiant

SUBCRIBED AND SWORN TO before me this __ day of January 2018, in Calapan City,
Oriental Mindoro, Philippines, affiant exhibiting to me his valid proof of identification.

Doc. No. _____;


Page No. _____;
Book No. _____;
Series of 2018.

You might also like