Republic of the Philippines)
Province of Aklan ) S.S.
x-----------------------------x
AFFIDAVIT OF LOSS
I, _______________, of legal age, married and a resident of 745
Rizal St., New Washington, Aklan after having been duly sworn in
accordance with law do hereby depose and state:
That I am the Owner of __________________ located at
Barangay Cawayan, New Washington, Aklan, Philippines;
That the above-mentioned business is the holder of Taxpayer’s
Identification Number (TIN) ______________________, and
was issued by the Bureau of Internal Revenue an Official Receipt Booklet
No. 8 with Series Number ____________;
That said Official Receipt Booklet No. 8 with Series Number
________ was in my possession from the time of issuance but sometime
on the month of December of 2017, when I was checking and organizing my
documents, the said Official Receipt Booklet No. 8 with Series Number
__________ could no longer be located and was missing from the usual
place it was being kept;
Diligent efforts were made to recover the same, but said efforts
proved futile and in vain, so I considered it lost.
That said Official Receipt Booklet No. 8 with Series Number
_________ was not confiscated from me by any competent authority nor
delivered to any person to secure any obligations
As such, I am executing this Affidavit of Loss to attest to the truth of
the foregoing and for whatever legal purposes that this may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this June 25,
2018 at Kalibo, Aklan, Philippines.
_____________
Affiant
SUBSCRIBED AND SWORN to before me this June 25, 2018 at
Kalibo, Aklan, Philippines by ____________________, who has
satisfactorily proven to me his identity through his Drivers’ License No.
__________________________, for his identity, known to me to be
the same person who personally signed before me the foregoing Affidavit
and acknowledged that he executed the same.
Doc. No. 485;
Page No. 98;
Book No. V;
Series of 2018.