Republic of the Philippines}

-__________________ }S.S.

AFFIDAVIT OF LOSS

I, _________________________, Filipino, of legal age, married,

and a resident of _______________________, under oath state that:

1. I am a ________________________, which has office

address at _________________________;

2. Sometime in _________________, I became an employee

of __________________________ with address at
_______________________. _______________ was my first employer.

3. My then employer secured a taxpayer identification

number _________________ for me from the appropriate Revenue
District Office of the Bureau of Internal Revenue. With the
designation of the TIN for me, came the TIN card.

4. After TIN card was delivered to me, I kept it in a desk

drawer at my residence in ___________________. I only took the TIN
card from that drawer whenever necessary.

5. Earlier this month, I conducted a general cleaning of my

residence. During this general cleaning, I was surprised to discover
that the TIN card was no longer in the ____________ where I kept it. I
searched for the TIN card in ___________________, but I was unable
to locate it.

6. Despite diligent search, I have failed to locate the original

TIN card issued to me by the BIR. Thus, I am executing this Affidavit
to declare the loss of my original card and to support my application
for the issuance of new TIN card in lieu of the lost one.

7. I have nothing further to state.

IN WITNESS WHEREOF, I hereby affix my signature this

_________________ in _____________________.

1
 _______________________________
Affiant

SUBSCRIBED AND SWORN before me a notary public in

_______________________ this _______________, affiant personally
appeared before me exhibiting his
_________________________________, and bears his photograph and
signature.

Doc. No. ____;

Page No. ____;
Book No. ____;
Series of 2018.