Republic of the Philippines )

, ) S.S.

AFFIDAVIT OF LOSS

KNOW ALL MEN BY THESE PRESENTS:

I, REYNALDO L. SALVADOR JR. of legal age, Filipino, single/married, and a resident of

PH4 BLK 12 LOT 11 NATIVIDAD SUBD., DEPARO, CALOOCAN CITY , after
having been sworn in accordance with law, hereby deposes and states the following:

1. I am holder/owner/ or possessor of the following identification card / document:

BUREAU OF INTERNAL REVENUE TIN CARD ID NO. 245-978-948-000

2. I have recently discovered the said item/s is/are irretrievably lost and can no longer
be found despite diligent efforts to locate the same;

3. I execute this affidavit to attest to the truth of the foregoing.

Signed on the date and at the place indicated below.

Affiant
REYNALDO L. SALVADOR JR.
Competent Evidence of Identity

SUBSCRIBED and SWORN TO before me on the date and at the place indicated below. The
affiant exhibited to me his competent evidence of identity as indicated above.
Signed this at , , Philippines.

WITNESS MY HAND AND SEAL.

Notary Public

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