(Affidavit of Loss DTI Certificate of Registration)

Republic of the Philippines)

Province of ____________________)S.S.
City/Municipality of _____________)
x-------------x
AFFIDAVIT OF LOSS
I, _____________, Filipino, of legal age, (single / married / widow),
and a resident of _____________, Philippines, after being duly
sworn in accordance with law, depose and state:
That I am an Owner of the business name "_____________" which
is registered with the Department of Trade and Industry (DTI)
pursuant to the provisions of Act 3883, as amended by Act 4147
and RA 863;
That I was issued a Certificate of Business Name Registration on
_____________ with No. _____________ which is valid from
_____________ to _____________;
That recently, when we looked for the original copy of the said DTI
Certificate Business Name Registration, the same could not be
found and must have been misplaced 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;
As such, I am executing this Affidavit of Loss to attest to the
truth of the foregoing and for whatever legal purposes that this
Affidavit may serve.

IN WITNESS WHEREOF, I have here unto set my hand this

_____________ at _____________, Philippines.

__________
AFFIANT

SUBSCRIBED AND SWORN to before me, this ______________in

__________________, affiant who exhibited her government ID as

competent proof of her identity.

Doc. No._________

Page No._________

Book No._________

Series of 2019