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Republic of the Philippines )

City of Tarlac )

AFFIDAVIT OF LOSS

I, MALY YANN, of legal age, its complicated, and a resident of Dito St.,
Brgy. Lang Sa, Tarlac after being duly sworn according to law, do hereby depose
and state that:

1. I am the owner of MASSA RAP BAKERY, with business address located


at Samin Lang Din, Tarlac;

2. Being registered with the Department of Trade and Industry (DTI) last May
2011, the said Government agency issued DTI Certification;

3. On August 2011, the original copy of the said DTI Certificate of


Registration could not be found, which is believe has been lost due on
typhoon flood;

4. Despite diligent search and best efforts, I failed to locate and recover the
said DTI Certification to this day;

5. Wherefore, I am executing this Affidavit of Loss to attest to the truth of the


foregoing and for whatever legal purposes that this may serve;

WITNESS WHEREOF, I have hereunto affixed my signature this 18th day


of October 2016 at Tarlac City, Philippines.

_____________________________
MALY YANN
SSS NO: 3X-2X2X3474-0

SUBSCRIBED AND SWORN TO before me, a notary public in and for Tarlac
City this 18th day of October. The affiant, whom I identified through the following
competent evidence of identity: SSS NO: 33-2058474-0, issued by Social Security
System(SSS), personally signed the foregoing instrument before me and vowed
under penalty of law to the whole truth of the contents of said instrument.

Doc. No. __________


Page No. __________
Book No. __________
Series of 2016.

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