REPUBLIC OF THE PHILIPPINES)

CITY OF LAOAG ) S.S.

AFFIDAVIT OF LOSS

I, , of legal age, single, Filipino, and a resident of

Brgy. , Philippines, after having been duly sworn to in
accordance with law, hereby voluntarily depose and state:

That I am a holder of a BUSINESS PLATE # for issued by

the City Government of ;

That I posted the said business plate in my place of

business;

That sometime in February 2019, my business place was

renovated;

That after the renovation, I discovered that said

Business Plate is no longer in my place of business;

Despite diligent search and efforts to locate the said

BUSINESS PLATE, I could not find it;

That said BUSINESS PLATE was not confiscated by any

authorities or by reason of any violation against the law; and

That I am executing this affidavit to attest to the

truthfulness of the above-cited facts and that I have
voluntarily executed this instrument.

IN TRUTH WHEREOF, I have hereunto set my hand this ______

day of ____________________ at Laoag City, Philippines.

Affiant
NPDL #A03-17-000371
 SUBSCRIBED AND SWORN to before me this ________________
at , Philippines. Affiant exhibited to me his competent proof
of identity indicated below his name and signature.