Republic of the Philippines)

La Trinidad, Benguet) s.s

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

AFFIDAVIT OF LOSS

I, Deisy P. Camodag of legal age, single, Filipino, and resident of Ampusongan,

Bakun, Benguet, Philippines, after having been duly sworn to in accordance with law, do
hereby depose and state THAT:

1. The Bureau of Internal Revenue had issued me a Taxpayer’s Identification

Number Card (TIN ID Card) and I had kept it for a longer period of time until it
got lost/missing sometime in 2019. The facts of the loss are as follows:

Sometime in 2019 , when I am still in Japan working as baker in Japan

and when my contract is about to expire, I need to extend my contract.
Therefore, the agency asked me to surrender my passport with the agency
and also some other documents while waiting to return from my work
abroad. Hence, to my recollection I packed all my belongings and personal
things ready for traveling going back home. However, after I reach my
destination and finally got home here in the Philippines, when I checked my
wallet and bag I noticed that my BIR TIN ID card was missing. I therefore
immediately tried to search in the premises and even asked my companions
about the same but I was unable to find it despite diligent effort to find.

2. In view of the foregoing, I strongly believed that my said BIR (TIN ID) Card
has been inadvertently lost without any deliberate intent on my part
whatsoever. Therefore, I considered it lost and beyond recovery;

3. I respectfully and earnestly request the Bureau of Internal Revenue (BIR) to

issue in my name another TIN ID Card as a replacement in lieu of the one
which was lost;

4. The said TIN ID Card was not confiscated by any Government authorities nor
delivered to any person or entity for the enforcement of civil obligation but due
solely to the afore-cited reason;

5. Finally, I am executing this affidavit to attest to the truthfulness of the

foregoing facts and for all legal intents and purposes it may serve well.

IN WITNESS WHEREOF, I have hereunto set my hand this October 7, 2020 at

La Trinidad, Benguet, Philippines.

Deisy P. Camodag
Affiant
Passport No P 2047066B

SUBSCRIBED AND SWORN to before me a Notary Public for and in La Trinidad,

Benguet, Philippines this October 7, 2020 by the above Affiant personally known to me of her
identity and identified by me to be the same person who personally signed before me the
foregoing Affidavit.

ATTY. CYRUS C. CALAYA

Doc. No. 366; Notary Public until December 31, 2021
Page No. 74; PTR No. BGTCF 6232438; January 10, 2020
Book No. I; IBP Lifetime No. 08051, at Pasig City
Series of 2020; Roll No. 52590, May 12, 2006; Manila
S & B Bldg., FA 224, Km. 4 National, Highway
La Trinidad, Benguet