REPUBLIC OF THE PHILIPPINES )

CITY OF CABANATUAN ) S.S.

AFFIDAVIT OF LOSS
OF BIR CERTIFICATE OF REGISTRATION
(COR)

I, FERNANDO F. FLORA, of legal age, Filipino and a resident of #884 J.P. Rizal
Street Nangka Marikina City, after having been sworn to in accordance with law, hereby
depose and state the following:

1. That I am the owner of HOMECOURT TRADING located at #884 J.P. Rizal

St., Nangka Marikina City.

2. That HOMECOURT TRADING was duly registered with the Bureau of Internal
Revenue (BIR) with Tax Identification No. 445-438-057-000 and was therefore
issued a BIR CERTIFICATE OF REGISTRATION (BIR Form 2303);

3. That unfortunately, the original copy of BIR Certificate of Registration issued

by the BIR RDO 045 was lost and I took pains to look for the original copy of
said BIR Certificate of Registration but to no avail;

4. That I am executing this affidavit to support my request with the Bureau of

Internal Revenue (BIR) for the reissuance of a new BIR Certificate of
Registration and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my signature this day of ,

2018 at Cabanatuan City.

FERNANDO F. FLORA
Affiant
ID No:
Issued by:

SUBSCRIBED AND SWORN to before me at the place and date above stated. I
hereby certify that I personally examined the affiant and am convinced that she
voluntarily executed the foregoing affidavit, read the same and understood its contents.

WITNESS MY HAND AND NOTARIAL SEAL.

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