Republic of the Philippines

))
)) S.S.
AFFIDAVIT OF LOSS
I, NAME, of legal age, with office address at ____________________, after having
been sworn to in accordance with law hereby depose and state:
1. I am the POSITION of NAME OF CORPORATION, a corporation duly existing under
the laws of the Philippines, and duly registered with the Bureau of Internal Revenue
(BIR) with TIN NUMBER;
2. As proof of registration with the BIR, the corporation was issued a CERTIFICATE OF
REGISTRATION (Certificate);
3. However, the Certificate was misplaced and can no longer be found or located
despite diligent efforts exerted. To the best of my knowledge, the same has been
lost.
4. I confirm that the Certificate described above have not been confiscated by any
officer of the law or the issuing office or agency due to the violation of any law,
statute, order, rule or regulation.
5. In the event that the lost Certificate should hereafter be found or located, I
undertake to forward or surrender the same to the BIR for appropriate disposal.
6. I am executing this Affidavit to attest to the truth of the foregoing statements and
to request the issuance of a new Certificate of Registration in lieu of that which was
lost.
IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of April
2016 in Taguig City.

NAME
Affiant
SUBSCRIBED AND SWORN to before me this
_______________,
Philippines,
by
affiant
exhibiting
______________________ as competent evidence of identity.

Doc. No.: _______;

Page No.: _______;
Book No.: _______;
Series of 2016.

_______________ at
to
me
his/her