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REPUBLIC OF THE PHILIPPINES}

DONE IN THE CITY OF BAGUIO} S.S.

AFFIDAVIT OF LOSS

I, REI ANN CAYETANO, of legal age, Filipino citizen and with


postal address at II Suyoc Tagley Hill Loakan Proper, Baguio City,
Philippines, after having been duly sworn to in accordance with law,
hereby depose and state:

1. That I am the holder and lawful possessor of a Certificate of


Registration duly issued by the Bureau of Internal Revenue;

2. That I kept the said COR in my office and had always been in my
possession;

3. That on September of 2009, my office was ransacked by thieves;

4. That when I checked my COR, I discovered that the same was


missing;

5. That my COR might have been stolen by the thieves that entered
my office back in 2009;

6. That I exerted my effort to locate the said COR but my efforts


proved futile and that the said COR is now considered lost and
beyond recovery;

7. That I did not cause the said incident to be entered into the blotter
entry of the Police Office having jurisdiction with the said area
thereof;

8. That I am executing this affidavit to attest to the truthfulness of all


the foregoing and for all legal intents and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 13 th


day of June 2016 at Baguio City, Philippines.

REI ANN CAYETANO


Affiant
UNIFIED MULTI-PURPOSE ID NO. CRN-0111-0960642-7

SUBSCRIBED AND SWORN to before me this 13th day of June


2016 at Baguio City, Philippines.