Republic of the Philippines )

City of Iloilo ) S.S.

AFFIDAVIT OF LOSS

KNOW ALL MEN BY THESE PRESENTS:

I, KATHERINE LAVIDA, of legal age, Filipino, single/married, and a resident of

No. 6 Brgy. Sta. Rosa, Guimbal, Iloilo , after having been sworn in accordance with law,
hereby depose and state the following:

1. That I am a holder of a Business Permit which was registered under my name for
the year 2018 at the Municipality of Guimbal.

2. That after securing the Business Permit from the Municipality of Guimbal, I
placed it inside a brown envelope and kept it inside my cabinet.

3. That sometime around May 25, 2018, I transferred some of my documents and
things on my new apartment at Villa Arevalo, Iloilo City.

4. That due to the number of things and documents I need to transfer from one place
to another, I inadvertently lost the said Business Permit.

5. That despite diligent search and effort to locate the said envelope and my
Business Permit, I could not find them such that I now believe that they are
now lost beyond recovery.

6. That I took pains to look for it but to no avail.

7. I execute this affidavit to attest the truth of the foregoing.

IN WITNESS WHEREOF, I have hereunto set my hand this _________ day of

_______________. 2019 at _________________________.

__________________________
Affiant

SUBSCRIBED and SWORN TO before me on the date and at the place indicated below.
The affiant exhibited to me his competent evidence of identity as indicated above.
Signed this ______________at ________________, ______________________,
Philippines. WITNESS MY HAND AND SEAL.
Notary Public