Republic of the Philippines

City of Tacloban

AFFIDAVIT OF LOSS

I, ZENAIDA P. GRAVOSO, of legal age, married, Filipino, and currently a

Brgy. 02 Sto. Niño Ext., Tacloban City, after having been duly sworn to in
accordance with law, hereby depose and say, THAT:

a. I am a holder of a Tax Identification Number (TIN)

Card with No. 131-437-019

b. However, the aforementioned ID Card, together with

my other personal documents have been lost/washed
out during the onslaught of Super Typhoon Yolanda
last Novemner 8, 2013;

c. I exerted utmost efforts to have the same ID Card

located and found but until this time it was not
anymore found such that I believe that it is now lost
forever and is beyond recovery;

d. The said issued identification card was not confiscated

for any violation of laws , rules or regulations;

e. I am executing this sworn declaration to affirm and

confirm the truth of the foregoing statements AND for
the purpose of processing the application for the
issuance of new TIN ID Card.

IN WITNESS WHEREOF, I have hereunto set my hand this 20 th February

2019 at the City of Tacloban, Philippines.

ZENAIDA P. GRAVOSO
Affiant
OSCA ID No. 3611243

SUBSCRIBED and SWORN TO BEFORE ME this 20th February 2019 at

Tacloban City, Philippines, affiant having personally shown to me her
identification card above-stated as proof of her identity.

Doc: ATTY. SHARON R. VILLONES

Notary Public
Page: N.C. No. 2019-01-53 until December 2018
IBP Lifetime No. 017319
Book: Roll No. 67394/May 24, 2017
Series of 2019 PTR No. 2613151/Jan 16, 2019/Palo, Leyte
Kertz Apartment, Fatima Village
Brgy. 77 Marasbaras, Tacloban City 6500