REPUBLIC OF THE PHILIPPINES)

Province of ____________________) S.S.

City/Municipality of _____________)
x-----------------------x

AFFIDAVIT OF LOSS

I, DON V. SALA, Filipino, of legal age, single, and a resident of Brgy. Mag-ata, Tomas
Oppus, So. Leyte, Philippines, after being duly sworn to in accordance with law, hereby depose
and state:

1 That I am a holder of BIR TIN ID;

2 That sometime in the year 2017, while I was travelling from North Olympus,
Novaliches City to Aurora, Cubao, QC, I lost my wallet which I usually place in my
back pocket;

3 That inside the said wallet are my identification cards, including my BIR TIN ID;

4 That despite diligent search and efforts to locate the said wallet and my BIR TIN ID,
I could not find them such that I now believe that they are now lost beyond recovery;

5 As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing
and to support my application for the issuance of a new BIR TIN ID, in lieu of the
one that was lost.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________ at

_____________, Philippines.

DON V. SALA
AFFIANT