REPUBLIC OF THE PHILIPPINES)

DONE IN THE CITY OF BAGUIO )S.S.

_________________________________

AFFIDAVIT OF LOSS

I, DELMA T. LAVA, of legal age, Filipino citizen, with residence at No. 20 City Camp
Central, Baguio City, after having been sworn to in accordance with law, hereby depose and say
that:

1. On August 31, 2009, I opened a business which I registered with the City Treasurer’s
Office, Baguio City Hall, Baguio City and of which I was able to secure my business
permit for such an endeavour;

2. However, since I was still employed then with the Office of Senator Antonio “Sonny”
F. Trillanes IV, the business venture which I had set up never had the chance to
operate;

3. I never even had a chance to renew my business permit every year;

4. And in fact, since I transferred from one residence to the other until I finally retired
from work, the business plate number I was issued upon my initial registration has
been missing and I indeed have exerted efforts to look for the same as I then
intended to surrender it but since I was not able to find it and due to my heavy
workload, I even forgot surrendering my business license with the City Treasurer’s
Office;

5. I am executing this Affidavit to attest to the truthfulness and veracity of the foregoing
facts for the purposes of:

a. Reporting to the Bureau of Internal Revenue (BIR) that my intended business

venture never operated and never earned any income whatsoever;

b. Report the fact of loss of my business license and plate number with the Office
of the City Treasurer;

c. Surrender my business license due to non-operation with the City Treasurer’s

Office and for all other legal intents and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 6 th day of December 2016 in
the City of Baguio, Philippines.

DELMA T. LAVA
Affiant

SUBSCRIBED AND SWORN TO before me this 6th day of December 2016 in the City of
Baguio. Affiant exhibited to me her Senior Citizen’s ID No. 14159 issued on July 19, 2013 at
Baguio City.