Republic of the Philippines )

Camiling, Tarlac
) S.S.

AFFIDAVIT
I, FELICITAS ANDRES y JAVIER, 73 years old, Filipino citizen,
married, and a resident of Barangay Tambugan, Camiling, Tarlac, Philippines,
after having been duly sworn to in accordance with law, do hereby depose and
state THAT:
1. I am the sole proprietor of ARIES STAR FURNITURE &
CONSTRUCTION SUPPLY located at Barangay Tambugan, Camiling,
Tarlac;
2. After several years of operation and on May 8, 2005, due to
diminishing returns, I ceased operating the said business and since
then, I did not have any transaction in connection therewith;
3. I am executing this Affidavit to inform the concerned agencies of the
cessation of ARIES STAR FURNITURE & CONSTRUCTION SUPPLY on
May 8, 2005 and that since then, I have not entered into any
transaction in relation to such business or business name;
4. Finally, I am executing this Affidavit to attest to the truth of the
foregoing statements and for whatever legal intents and purposes this
may serve.
IN WITNESS WHEREOF, I have hereunto affixed my signature this 18 th
day of November, 2015 at Camiling, Tarlac, Philippines.
FELICITAS J. ANDRES
Affiant
SUBSCRIBED AND SWORN to before me on the date and place
indicated above. Affiant exhibited to me her Senior Citizen Card with Control
No. 04292 issued by the Office of the Senior Citizens Affairs (OSCA), Camiling,
Tarlac.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2015

Republic of the Philippines )

Camiling, Tarlac
) S.S.

AFFIDAVIT OF LOSS
I, FELICITAS ANDRES y JAVIER, 73 years old, Filipino citizen, married,
and a resident of Barangay Tambugan, Camiling, Tarlac, Philippines, after having
been duly sworn to in accordance with law, do hereby depose and state THAT:
1. Sometime in the year 2004, I registered my business with a trade name
ARIES STAR FURNITURE & CONSTRUCTION SUPPLY located at my abovestated address, with the Bureau of Internal Revenue (BIR) Camiling,
Tarlac and I was issued the following, to wit:
A. BIR - Certificate of Registration (COR),
B. BIR POSTER (Ask for Receipt),
C. Unused Invoices / Receipts with Inventory List
These documents were placed in my aforesaid business establishment;
2. Sometime in the year 2005, our town was heavily flooded due typhoon.
As a result, most of my personal belongings and pertinent documents
inside my store were destroyed and some were transferred from one
place to another for safekeeping including the above-enumerated
documents/receipts;
3. I am executing this Affidavit with the intent of informing the concerned
agency
about
the
loss/destruction
of
the
above-enumerated
documents/receipts;
4. Finally, I am executing this Affidavit to attest to the truth of the foregoing
statements and for whatever legal intents and purposes this may serve.
IN WITNESS WHEREOF, I have hereunto affixed my signature this 18th
day of November, 2015 at Camiling, Tarlac, Philippines.
FELICITAS J. ANDRES
Affiant
SUBSCRIBED AND SWORN to before me on the date and place indicated
above. Affiant exhibited to me her Senior Citizen Card with Control No. 04292
issued by the Office of the Senior Citizens Affairs (OSCA), Camiling, Tarlac.

Doc. No. _____

Page No. _____

Book No. _____

Series of 2015