REPUBLIC OF THE PHILIPPINES)
PROVINCE OF PANGASINAN)
CITY OF ALAMINOS) S.S
*----------------------------------------*
AFFIDAVIT OF LOSS OF PERMIT TO USE (PTU) LOOSE-LEAF FOR INVOICES/RECEIPTS
AND OTHER ACCOUNTING RECORDS
I, __________________________, of legal age, Filipino citizen, and with residence
address at 150 Palali St., Poblacion, Alaminos City, Pangasinan, Philippines, after being duly
sworn to in accordance with law, hereby depose and state;
1. That I am the accounting staff of __________________________, a corporation duly
organized and existing under and by virtue of laws of the Republic of the Philippines with
principal office address at Brgy. Tagudin, Mabini, Pangasinan with Tax Identification
Number ______________;
2. That being registered with the Bureau of Internal Revenue District No. 05
______________ has been issued a ________________ issued on _________________;
3. That sometime on ______________ the original copy of the said permit could
not be found and that despite of diligent search and efforts, the same could
no longer be found such that I now believe that it is now lost beyond
recovery;
4. That said certificate has not been confiscated by reason of any violation of
rules and regulations of any government agency or private institution;
5. That I am executing this affidavit to certify or attest to the truth of the
foregoing facts to support my application for the issuance of new permit in
lieu of the one that was lost.
IN TRUTH WHEREOF, I have hereunto signed my name below this
_________________, in Alaminos City, Pangasinan.
____________________________
Affiant
JURAT
SUBSCRIBED AND SWORN to before me this ______________, the affiant is
exhibiting to me his competent proof of identity.
Doc. No.
Page No.
Book No.
Series of 2024.