Republic of the Philippines)

La Trinidad, Benguet) s.s

x- - - - - - - - - - - - - - - - -x

AFFIDAVIT OF LOSS

I, TYRON A. ELWAS, of legal age, Filipino, and resident of Camp Lolita Acupan,
Virac, Itogon, Benguet after having been duly sworn to in accordance with law, do
hereby depose and state THAT:

1. I am bonafide holder of a Tax Identification Card (TIN Card) duly issued by the
Bureau of Internal Revenue (BIR), La Trinidad, Benguet-District Office;

2. The said TIN Card has been kept for a long time in our house. However, when
I checked the same, I discovered that my said TIN Card is missing. I tried to
search in some the places at home where some documents are being kept
but I cannot able to find the same. I inquired the members of my family if they
have knowledge as to its whereabouts but they have not seen about it. I
strongly believed that the said TIN Card has been inadvertently misplaced
without any malice or negligence on my part whatsoever. In view thereof, I
therefore considered my said TIN card as loss and beyond recovery;

3. My said TIN Card has neither been used for any illegal activities nor
intentionally loss but due to the afore cited reason;

4. I am executing this Affidavit to plead and request the Bureau of Internal

Revenue (BIR), La Trinidad, Benguet-District Office to issue me a new Tax
Identification Card (TIN Card) in lieu of the lost one. That, I hereby bind myself
to fully excuse the said office for any damage that it may incur for the
issuance of the requested TIN Card;

5. Finally, I am executing this affidavit to attest to the truthfulness of the

foregoing facts and for all legal intents and purposes it may serve well.

IN WITNESS WHEREOF, I have hereunto set my hand this 15th day of March
2017 at La Trinidad, Benguet, Philippines.

TYRON A. ELWAS
Affiant

SUBSCRIBED AND SWORN to before me a Notary Public for and in La Trinidad,

Benguet, Philippines this 15th day of March 2017 by the above Affiant personally known to
me of his identity and identified by to be the same person who personally signed before me
the foregoing Affidavit.

ATTY. CYRUS C. CALAYA

Doc. No. 489; Notary Public until Dec. 31, 2017
Page No. 98; PTR No. BGT 5080030; Feb. 15, 2017
Book No. I; IBP Lifetime No. 08051, at Pasig City
Series of 2017. Roll No. 52590, May 12, 2006; Manila
S & B Bldg., FA 224, Km. 4
National, Highway La Trinidad, Benguet