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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.