REPUBLIC OF THE PHILIPPINES)

MUNTINLUPA CITY ) S. S.

AFFIDAVIT OF LOSS
I, _______________________________, of legal age, Filipino, single/married, and a
resident of __________________________________________, after being duly sworn to in
accordance with law depose and say:

1. That a Certificate of Registration was issued under my name by the Bureau of

Internal Revenue (BIR);

2. That I use to keep the said Certificate of Registration in my files for convenience and
safety purposes;

3. That on ___________________, when I was about to use the said CR, I discovered
that it was already lost/missing;

4. That diligent effort was already exerted to locate the said CR but all effort proved
futile and the same could no longer be found;

5. That I believe they are now beyond recovery;

6. That I am executing this affidavit to attest to the truth of the foregoing facts and for
the purpose of reporting the loss and for whatever legal purpose/s this may serve.

IN WITNESS HEREOF, I am affixing my signature this _____________________ at

Muntinlupa City.

______________________________
Affiant
________ I.D. No. ______________

SUBSCRIBED AND SWORN to before me this ________________ at Muntinlupa

City. Affiant exhibited to me his/her Competent Evidence of Identity abovementioned.