Republic of the Philippines )

City of Davao ) S.S.

AFFIDAVIT OF LOSS

I, ARIEL V MENDOZA JR, married, of legal age, Filipino, and a resident of

Toril, Davao City, after being duly sworn to in accordance with law, do hereby
depose and state;

1. That I am an owner of Tax Identification Number Card or

TIN Card;

2. That I have lost the said TIN ID in the house last June 2016

3. That I have searched for my TIN ID with due diligence but

have not found it;

4. That I declare that the same is lost and can never be found;

5. I am executing this Affidavit in good faith, for whatever legal

purpose it may serve and to attest to the veracity of the
foregoing;

IN WITNESS WHEREOF, I have hereunto set my hand this July 20, 2016,
2016 at Davao City, Philippines.

ARIEL V MENDOZA JR
Affiant
Company ID- 900386

SUBSCRIBED AND SWORN TO before me, this July 20, 2016 at Davao City,
Philippines, affiant personally appeared to me.

Doc. No.:
Page No.:
Book No.:
Series of 2016