AFFIDAVIT OF LOSS

I, ----------------------------------------, of legal age, married, Filipino, and a resident of

-----------------------------------, under oath, depose and state that:

1. I am PRESIDENT and Authorized Representative of

-----------------------------------------, a Corporation duly existing under laws of
the Republic of the Philippines with office address at
------------------------------;

2. The said business is duly registered with the different government agencies
including the Bureau of Internal Revenue (BIR);

3. Upon registration with the BIR, the Corporation applied for authority to
print receipts necessary for its transaction;

4. The application was approved and receipts (Official Receipt) were printed in
favor of the Corporation;

5. The receipts were delivered to the Corporation and was kept at its office
since there were no transactions yet under the name of the Corporation;

6. Just recently, the office discovered that the receipts issued for the
Corporation are missing;

7. Diligent efforts were exerted in order to locate the whereabouts of the

missing receipts, unfortunately, to no avail. Hence, it is now presumed to
have been totally lost; and,

8. I am executing this affidavit to attest to the truthfulness of the foregoing

statements and for the purpose of replacing the lost receipts.

IN WITNESS WHEREOF, I have hereunto set my hand this __________________

at __________________________.

__________________________
Affiant
ID: ________________________

Republic of the Philippines }

Province of ____________ } Sc.
_____________________ }
x----------------------------------x

SUBSCRIBED AND SWORN to before me this __________________ at

__________________, by the affiant, who signed in my presence the foregoing affidavit,
who avowed to the veracity thereof and acknowledge to me that it is his free act and
deed.

WITNESS MY HAND AND SEAL.

Doc. No.: _____;

Page No.: _____;
Book No.: _____;
Series of 2023.