REPUBLIC OF THE PHILIPPINES

CITY OF URDANETA } S.S.

AFFIDAVIT OF LOSS
I, JOMAR TORRES FLORES, of legal age, Filipino, married, and with office address
at McArthur Highway, Brgy. Poblacion, Urdaneta City, Pangasinan, after having sworn to in
accordance with law, hereby, depose and state that:

1. I am the Current Manager of Fresh N’ Famous Foods, Inc., which operates the
Chowking Urdaneta Branch located in McArthur Highway, Brgy. Poblacion, Urdaneta City,
Pangasinan;

2. Fresh N’ Famous Foods, Inc. was issued by the Bureau of Internal Revenue (“BIR”)
with a TIN No. 000-333-173-592; Fresh N’ Famous Foods, Inc. received through a previous
Manager Cherie Lavarias an Authority to Print (“ATP”) for the purpose of authorizing a printer
to print Fresh N’ Famous Foods, Inc.’s receipts for its Chowking Branch;

(Attached herein and marked as ANNEX “1” is a photocopy of the lost BIR-issued ATP, and
made an integral part of this Affidavit.)

3. The said ATP was lost and could not be located by me or my staff;

4. I exerted diligent efforts to locate the same, but to no avail, and hence it is considered
lost and beyond recovery;

5. Said ATP was never confiscated, revoked, cancelled, or in any way made ineffective
due to violation of any law, rule, or regulation;

6. As a requirement for the issuance of another ATP in lieu of the lost one, I am required
to execute an affidavit of loss;

7. In compliance with the abovementioned requirement, I hereby execute this affidavit

to request the BIR to issue to me a new ATP for Fresh N’ Famous Foods Inc’s Chowking Branch
in lieu of the lost one; and

8. I am executing this affidavit to attest to veracity of the foregoing facts and for
whatever legal purpose it may serve.

IN WITNESS WHEREOF, I hereunto affix my signature this 28th day of July 2020 in the
City of Urdaneta.

_______________
JOMAR T. FLORES
Affiant

SIGNED IN THE PRESENCE OF:

___________________________ ___________________________
Witness Witness

SUBSCRIBED AND SWORN to before me on the date and place first above written,
affiant presenting to me, as competent proof of identity his Driver’s License C11-02-151850 valid
until 2021/12/09 at the Tarlac.

Doc No.:
Page No.:
Book No.: I
Series of 2020.