Republic of the Philippines)

C I T Y O F D A V A O ) SS.
x- - - - - - - - - - - - - - - - - --x
AFFIDAVIT OF LOSS
I, NOELITO NIO S. ROSELLO, Filipino, of legal age, married, and a
resident of Davao City, after being duly sworn to in accordance with law do
hereby depose and say that:
1. I am the sole proprietor of TWO NR Marketing, with business
address at 101-B Gladiola St. Buhangin. Davao City;
2. Sometime on October 2014, I applied for registration of the
abovesaid business with the Bureau of Internal Revenue which was
correspondingly approved;
3. Unfortunately, on or around January 2015, I inadvertently misplaced
the claim-stub to be presented in order to be issued the Certificate of
Registration of the business by the Bureau of Internal Revenue.
4. Notwithstanding diligent efforts exerted to find it, the same was not
found, recovered, or located, hence, considered lost and destroyed
for all intents and purposes.
5. I am executing this affidavit without any fraud or intent to deceive on
my part and I forever free any person from any liability that may
arise from this circumstance, and/or any entity, be it governmental or
private.
6. I am therefore executing this affidavit to attest to the truth of all the
foregoing and to apprise the Bureau of Internal Revenue as well as
any person, natural and juridical, governmental or private of such
fact of loss and for all other legal purposes that this affidavit may
serve.
IN WITNESS WHEREOF, I have hereunto affixed my signature this
_______________, at Davao City, Philippines.
NOELITO NIO S. ROSELLO
Affiant
Prof License No. L06-05-001901 Valid until 12-14-2016
SUBSCRIBED and SWORN to before me, in the City of Davao, this
_________________, affiant exhibiting to me his/her competent evidence of
identity first written above below his/her name.
Doc No.________
Page No.________
Book No.________
Series of 2016.

ATTY. RALPH JAMES G. LAMAN

Notary Public
Until December 31, 2017
PTR No. 6544219 12/16/2015
IBP No. 0989195 12/15/2015
Roll No. 62810

MCLE Compliance Exempt1

1 Recently been admitted to the Bar on May 06, 2014.