REPUBLIC OF THE PHILIPPINES)

_____________________________ ) Sci.

AFFIDAVIT OF LOSS
KNOW ALL MEN BY THESE PRESENTS:

I, ________________________, Filipino, of legal age, with residential

address at ________________________after having been sworn in accordance
with law hereby depose and state:

That I am the owner of ________________________ with business address

at ________________________;

That I was issued a Notice to Issue Receipts/Invoices (NIRI) by the Bureau

of Internal Revenue (BIR)

That said NIRI was Lost when we move-out last July 2023 and I could no
longer locate the same despite diligent efforts;

That I am executing this Affidavit of Loss to attest to the truth of all the
foregoing and for all legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunder affixed my signature this

________________________, at ________________________, Philippines.

________________________

SUBSCRIBED and SWORN to before me this

________________________, affiant exhibiting to me his
________________________ issued by the ________________________ as
competent proof of his identity.

NOTARY PUBLIC

Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2023.