[Republic of the Philippines]

[City of Zamboanga ] S.S

X----------------------]

AFFIDAVIT OF LOSS

I, _____________ , of legal age, married, Filipino, a resident of Zamboanga City,

under oath, do hereby depose and say that:

I am in possession of a Department of Trade Industry (DTI)

registration issued to me by the Department of Trade Registration,
Zamboanga City;

That however, the said registration got lost from my possession. I

hid for safe-keeping purposes but the same went missing among my
personal belongings;

That diligent efforts were exerted to locate the same but the same
proved futile. Hence, I now consider it lost beyon the point pof recovery;

I am executing this affidavit to attest to the veracity of the

foregoing facts.

IN WITNESS WHEREOF, I have hereunto set my hand this 14th day of November
2017 in the City of Zamboanga, Philippines.

Affiant

SUBSCRIBED AND SWORN to before me this 14th day of November 2017 in the
City of Zamboanga, Philippines.

Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2017.