REPUBLIC OF THE PHILIPPINES )

City of Roxas ) S.S.

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AFFIDAVIT OF LOSS

I, ANTONETH G. HALANG, Filipino, of legal age, single and a resident

of Brgy. Pob. Takas, Cuartero, Capiz, after having been duly sworn in
accordance with law, hereby depose and state:

1. That I am a holder of a TIN Identification Card issued by Bureau

of Internal Revenue;

2. That the said TIN Identification Card was lost in my possession

and its whereabouts could not be ascertained;

3. That diligent effort to locate and search in places where I have

been on that day, I lost it; However said TIN ID Card was nowhere
to be found;

4. That said TIN ID Card was not confiscated by the authorities by

any reason. Neither I violated any rules and regulations;

5. That I am executing this affidavit to attest to the truth of the

foregoing facts and to request for a replacement of said TIN
Identification Card.

IN WITNESS WHEREOF, I have hereunto set my hand this 13 th day

of February 2020 at the Roxas City, Philippines.

ANTONETH G. HALANG
Teacher I.D No. 026

SUBSCRIBED AND SWORN to before me this 13th day of

February, 2020 in the City of Roxas, Philippines. I further CERTIFY that I
have personally examined the affiant, and I am fully satisfied that he
voluntarily executed the foregoing Affidavit, and he read and understood the
contents thereof.