REPUBLIC OF THE PHILIPPINES )

PROVINCE OF PAMPANGA )ss

MUNICIPALITY OF FLORIDABLANCA )

AFFIDAVIT OF LOSS

I, Ladino B. Morales Jr., of legal age, married, Filipino citizen and a resident of Apalit,
Floridablanca, Pampanga after being sworn in accordance with the law depose and say:

1. I am a holder of Ask for Receipt sign issued by Bureau of Internal Revenue;

2. The foregoing Ask for Receipt sign for Ladino Enterprises with TIN 417-432-632-000 was lost
on ________________ because ______________;

3. That despite diligent efforts has been exerted in order to find and locate the said Ask for
Receipt sign; the same could no longer be found and prove to be beyond recovery;

4. That this affidavit was executed to attest the truth of the foregoing and for purpose of the re-
issuance of the new Ask for Receipt sign in my favor and whatever legal purpose it may serve
best.

IN WITNESSS WHEREOF, I have here set unto my hand this 25th day of June, 2023 in the
Municipality of Floridablanca, Province of Pampanga.

LADINO B. MORALES JR.

Affiant

SUBSCRIBED AND SWORN to before me this __th day of June, 2023 at Floridablanca,
Province of Pampanga.

NOTARY PUBLIC

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