Sample Affidavit of Loss - BIR COR

REPUBLIC OF THE PHILIPPINES)
______________________ ) S.S.
AFFIDAVIT OF LOSS
I, _________________, Filipino, of legal age, with office address at

_____________________________________, after being duly sworn in accordance with law
hereby depose and state:
1. I am the ___________________ of ________________________________.
2. ________________________’s Tax Identification Number (TIN) is

_______________. It was registered with the Bureau of Internal Revenue (BIR) Revenue District
Office (RDO) No. ____ on ________________________.
3. _________________ was issued a Certificate of Registration (BIR Form No. 2303)

with ______________________.
4. _______________’s original BIR Certificate of Registration was misplaced and can

no longer be located despite diligent efforts on my part to look for the same.
5. This affidavit is executed to attest to the truth of the foregoing and for all legal
intents and purposes it may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of __________ 2017
at _______________.
______________________
Affiant
SUBSRIBED AND SWORN to before me this ____ day of ____________ 2017 at

____________________, affiant exhibiting to me his ___________________ issued on
_________________________ at ____________________________
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2017.
______________________ ) S.S.
AFFIDAVIT OF LOSS

1. I am the ___________________ of ________________________________.

Office (RDO) No. ____ on ________________________.

with ______________________.

at _______________.
______________________
Affiant

_________________________ at ____________________________
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2017.
______________________ ) S.S.
AFFIDAVIT OF LOSS

1. I am the ___________________ of ________________________________.

Office (RDO) No. ____ on ________________________.

with ______________________.

at _______________.
______________________
Affiant

_________________________ at ____________________________
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2017.
______________________ ) S.S.
AFFIDAVIT OF LOSS

1. I am the ___________________ of ________________________________.

Office (RDO) No. ____ on ________________________.

with ______________________.

at _______________.
______________________
Affiant

_________________________ at ____________________________
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2017.
______________________ ) S.S.
AFFIDAVIT OF LOSS

1. I am the ___________________ of ________________________________.

Office (RDO) No. ____ on ________________________.

with ______________________.

at _______________.
______________________
Affiant

_________________________ at ____________________________
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2017.
______________________ ) S.S.
AFFIDAVIT OF LOSS

1. I am the ___________________ of ________________________________.

Office (RDO) No. ____ on ________________________.

with ______________________.

at _______________.
______________________
Affiant

_________________________ at ____________________________
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2017.
______________________ ) S.S.
AFFIDAVIT OF LOSS

1. I am the ___________________ of ________________________________.

Office (RDO) No. ____ on ________________________.

with ______________________.

at _______________.
______________________
Affiant

_________________________ at ____________________________
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2017.
______________________ ) S.S.
AFFIDAVIT OF LOSS

1. I am the ___________________ of ________________________________.

Office (RDO) No. ____ on ________________________.

with ______________________.

at _______________.
______________________
Affiant

_________________________ at ____________________________
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2017.
______________________ ) S.S.
AFFIDAVIT OF LOSS

1. I am the ___________________ of ________________________________.

Office (RDO) No. ____ on ________________________.

with ______________________.

at _______________.
______________________
Affiant

_________________________ at ____________________________
Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2017.

Sample Affidavit of Loss - BIR COR

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REPUBLIC OF THE PHILIPPINES)

I, _________________, Filipino, of legal age, with office address at

1. I am the ___________________ of ________________________________.

2. ________________________’s Tax Identification Number (TIN) is

3. _________________ was issued a Certificate of Registration (BIR Form No. 2303)

4. _______________’s original BIR Certificate of Registration was misplaced and can

SUBSRIBED AND SWORN to before me this ____ day of ____________ 2017 at

Doc. No. ___;

I, _________________, Filipino, of legal age, with office address at

1. I am the ___________________ of ________________________________.

2. ________________________’s Tax Identification Number (TIN) is

3. _________________ was issued a Certificate of Registration (BIR Form No. 2303)

4. _______________’s original BIR Certificate of Registration was misplaced and can

SUBSRIBED AND SWORN to before me this ____ day of ____________ 2017 at

Doc. No. ___;

I, _________________, Filipino, of legal age, with office address at

1. I am the ___________________ of ________________________________.

2. ________________________’s Tax Identification Number (TIN) is

3. _________________ was issued a Certificate of Registration (BIR Form No. 2303)

4. _______________’s original BIR Certificate of Registration was misplaced and can

SUBSRIBED AND SWORN to before me this ____ day of ____________ 2017 at

Doc. No. ___;

I, _________________, Filipino, of legal age, with office address at

1. I am the ___________________ of ________________________________.

2. ________________________’s Tax Identification Number (TIN) is

3. _________________ was issued a Certificate of Registration (BIR Form No. 2303)

4. _______________’s original BIR Certificate of Registration was misplaced and can

SUBSRIBED AND SWORN to before me this ____ day of ____________ 2017 at

Doc. No. ___;

I, _________________, Filipino, of legal age, with office address at

1. I am the ___________________ of ________________________________.

2. ________________________’s Tax Identification Number (TIN) is

3. _________________ was issued a Certificate of Registration (BIR Form No. 2303)

4. _______________’s original BIR Certificate of Registration was misplaced and can

SUBSRIBED AND SWORN to before me this ____ day of ____________ 2017 at

Doc. No. ___;

I, _________________, Filipino, of legal age, with office address at

1. I am the ___________________ of ________________________________.

2. ________________________’s Tax Identification Number (TIN) is

3. _________________ was issued a Certificate of Registration (BIR Form No. 2303)

4. _______________’s original BIR Certificate of Registration was misplaced and can

SUBSRIBED AND SWORN to before me this ____ day of ____________ 2017 at

Doc. No. ___;

I, _________________, Filipino, of legal age, with office address at

1. I am the ___________________ of ________________________________.

2. ________________________’s Tax Identification Number (TIN) is

3. _________________ was issued a Certificate of Registration (BIR Form No. 2303)

4. _______________’s original BIR Certificate of Registration was misplaced and can

SUBSRIBED AND SWORN to before me this ____ day of ____________ 2017 at

Doc. No. ___;

I, _________________, Filipino, of legal age, with office address at

1. I am the ___________________ of ________________________________.

2. ________________________’s Tax Identification Number (TIN) is

3. _________________ was issued a Certificate of Registration (BIR Form No. 2303)

4. _______________’s original BIR Certificate of Registration was misplaced and can

SUBSRIBED AND SWORN to before me this ____ day of ____________ 2017 at

Doc. No. ___;

I, _________________, Filipino, of legal age, with office address at

1. I am the ___________________ of ________________________________.

1. I am the _ of ______________.

SUBSRIBED AND SWORN to before me this day of ________ 2017 at

1. I am the _ of ______________.

SUBSRIBED AND SWORN to before me this day of ________ 2017 at

1. I am the _ of ______________.

SUBSRIBED AND SWORN to before me this day of ________ 2017 at

1. I am the _ of ______________.

SUBSRIBED AND SWORN to before me this day of ________ 2017 at

1. I am the _ of ______________.

SUBSRIBED AND SWORN to before me this day of ________ 2017 at

1. I am the _ of ______________.

SUBSRIBED AND SWORN to before me this day of ________ 2017 at

1. I am the _ of ______________.

SUBSRIBED AND SWORN to before me this day of ________ 2017 at

1. I am the _ of ______________.

SUBSRIBED AND SWORN to before me this day of ________ 2017 at

1. I am the _ of ______________.

SUBSRIBED AND SWORN to before me this day of ________ 2017 at