Republic of the Philippines)

City of Zamboanga……………………….) s.s.

X--------------------------X

AFFIDAVIT OF LOSS
Re: BIR TIN APPLICATION FORM

I, JASMINE ALEXANDRA N. MOHAMMADSALI, of legal age, single,

Filipino Citizen, and presently residing at Zone II,Divisoria,
Zamboanga City Philippines, after having been duly sworn to in
accordance with law, hereby depose and say:

That sometime in 2008 I applied with Bureau Internal Revenue

(BIR), Zamboanga City for the issuance of Taxpayer’s
Identification Number(TIN) and as such I was issued BIR TIN
APPLICATION FORM and filed up the same;

That after a few months thereafter I was given Taxpayer’s

Identification Number(TIN) 269-581-450 written on the above BIR
TIN APPLICATION FORM, without a TIN I.D. being issued by the
Bureau Internal Revenue (BIR), Zamboanga City;

That sometime in 2009 while I was searching/looking for my

BIR TIN APPLICATION FORM among my personal files, I discovered
that same was missing/lost and I believe that the same had been
misplaced/lost by me or have fallen without my knowledge;

That despite having exerted diligent efforts to find/locate

my above-mentioned BIR TIN APPLICATION FORM my efforts proved
futile, hence, I considered same to be irretrievably lost and
beyond recovery;

That I am executing this affidavit to attest to the truth of

the foregoing facts and for whatever legal purpose this may
serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 18th

day of June 2013 in the City of Zamboanga, Philippines.

JASMINE ALEXANDRA N. MOHAMMADSALI

Affiant
City Government of Zamboanga Employee I.D. NO. 1-49

SUBSCRIBED AND SWORN to before me this 18th day of June

2013 in the City of Zamboanga, Philippines.

Doc. No._______
Page No._______
Book No._______
Series of 2013