REPUBLIC OF THE PHILIPPINES)

CITY OF ILOILO ) S.S.

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

AFFIDAVIT OF LOSS

I, _________________, of Legal Age, Filipino, single, with residential address at

____________________ subscribing under oath, hereby depose and state:

• That I have been issued Taxpayer’s Identification Card by the Bureau of Internal
Revenue (BIR) the number I could no longer remember;

• That sometime on December 4, 2019, I could no longer find the said Identification
Card inside my cabinet;

• Efforts were exerted to locate said Taxpayer’s Identification Card, but in spite of
diligent search, it could not be found and the same is now beyond recovery;

• As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing and
to support my application for the issuance of a new copy of Taxpayer’s
Identification Card in lieu of the one that was lost.

IN WITNESS WHEREOF, I have hereunto set my hand this ____________________

in Iloilo City, Philippines.

______________________________
Affiant

SUBSCRIBED AND SWORN TO before me this __________________ in

___________________, Philippines, affiant exhibiting to me his competent evidence of
identity by way of _______________________ issued at _________________ on
__________________.

Doc. No. _______;

Page No._______;
Book No._______;
Series of _______.