REPUBLIC OF THE PHILIPPINES)

PROVINCE OF TARLAC )S.S.

CITY OF TARLAC )

AFFIDAVIT OF LOSS
I, PAUL JOHN Y. CAPULONG, of legal age, single, Filipino citizen,
and resident and with postal address at Villa Leticia, Matatalaib, Tarlac
City, do hereby depose and say:

1. That I am the registered owner of a business under the trade

name of PYC VEGETABLES STORE located at Victory Up
Town Market;

2. That the above-said business was duly registered at the

Department of Trade and Industry (DTI) on January 11 , 2017
and was issued Certification of Registration with No. 04423885;

3. That recently, I checked the existence of the said Department

of Trade and Industry (DTI) ; however, the same could no
longer be found;

4. That I have exerted efforts to locate the same but all proved
futile;

5. That I hereby attest to the truth and veracity of the above-stated

statements and facts.x

6. That I am executing this affidavit to attest to the truth of the

foregoing statements.

IN WITNESS WHEREOF, I have hereunto set my hand this

________at Tarlac City, Philippines.

PAUL JOHN Y. CAPULONG

Affiant

SUBSCRIBED AND SWORN to before me this, _________at Tarlac

City, Philippines.

Doc.No._____;
Pag No._____;
Book No._____;
Series of 2018.