AFFIDAVIT OF LOSS OF BOOKS OF ACCOUNTS

I, ________________, of legal age, (civil status), Filipino citizen, with address at

____________________________________, having been sworn in accordance with law, hereby
depose and state:

1. That I am the President of _______________________;

2. That ___________________ is a domestic corporation with address at

_______________________________________;

3. The Company’s Books of Accounts which were duly registered with the Bureau of Internal
Revenue (BIR) are as follows:

a. (list of registered books)

4. On __________________, the Company’s books of accounts were destroyed in a fire,

covered by a Fire Incident Report issued by ___________________, attached herein as an
Annex.

5. That I am executing this affidavit to support our application for registration of new set of
books of accounts with the BIR.

IN WITNESS WHEREOF, I have set my hand this ___ day of _____________, in _______

Affiant

SUBSCRIBED AND SWORN to before me this ____________________, affiant exhibited to me

his _____________________ issued at _____________ with expiry date _____________.

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of _____.