REPUBLIC OF THE PHILIPPINES)

MUNICIPALITY OF SAN JUAN ) SS.

PROVINCE OF LA UNION )
AFFIDAVIT OF LOSS

I, MARIFI H. TAMAYO, of legal age, Filipino citizen, married and resident of and with postal
address at 375 Ili Norte, San Juan, La Union after having been duly sworn on oath in accordance
with law hereby voluntarily depose and say:
1. That I am the registered proprietor/owner of Halo-Halo Shop and General
Merchandising with business address at Ili Sur (Poblacion), San Juan, La Union with
Certificate of Regisration No. 4RC0000681072 dated September 21, 2021;
2. That as a consequence of my registration I was issued my business blue books for
accounting purposes and was required/approved to cause the printing of my business
Official Receipts;
3. That after a year of operation sometime in 2013, I was forced to “close-shop” due to
financial difficulties; thus, I have to move out my business equipment and inventory
together with my business records and transfer them to my residence at Ili Norte, San
Juan, La Union;
4. That from the time I ceased operation of my business in 2013, all my records pertinent
to the same were lost due to inadvertence and misplacements brought about by
events (e.g. typhoons, renovation of my house, and the likes), such that, to date I could
no longer locate the whereabouts of my business records (e.g. blue books and Official
Receipts) anent the Halo-Halo Shop and General Merchandising and despite serious
and diligent efforts on my part to find the same, my efforts proved to be futile and
such records/documents (e.g. my blue book records, business Official Receipts) are now
considered lost and beyond recovery;
5. That I intend to put up another business entity, MHTC FOOD PRODUCTS TRADING
(Regional) and now in the process of registering the same with the Bureau of Internal
Revenue, which now requires that I officially close my previous business entity (e.g.
Halo-Halo Shop and General Merchandising) from the records of the BIR;
6. That I am now executing this Affidavit of Loss for presentation as requirement for the
closure undertaking required and for my application for registration of my new
business entity with the BIR and for all other legal intents and purposes it may serve;
and
5. That I attest to the truthfulness and correctness of the above facts based on my
personal knowledge and verifiable documents that may be presented by the
undersigned affiant upon request by any concerned office or agency.

IN WITNESS WHEREOF, I have hereunto signed my name below, this 2nd day of December,
2021 at San Juan, La Union, Philippines.

MARIFI H. TAMAYO
Affiant

SUBSCRIBED AND SWORN to before me, this 2ND day of December, 2021 in San Juan, La
Union, Philippines, affiant exhibiting to me her competent proof of identity as NPDL AO4-11-
005146 valid until September 19, 2022 issued by the LTO – SFLU Office.