Republic of the Philippines)

City of Ozamiz) S.S.

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

Affidavit of Loss BIR Certificate of Registration

I, KAREN BELINA F. DE LEON, Filipino, of legal age, married, and with

residence at HT Feliciano St., Aguada, Ozamiz City, Philippines, after being duly
sworn to in accordance with law, hereby depose and state:

1. That I am the President of Misamis University Inc., which owns the

Misamis University Domestic Carrier registered with the Bureau of
Internal Revenue, with Tax Identification Number 000-721-324-007, the
particulars of which are described as follows:
Type: FVR Bus (Isuzu)
Plate No.: NAP - 8102
Engine No.: 6HK1620885
Chassis No: PABFVR34SLQC00115
2. That for several weeks now, the Misamis University Domestic Carrier
Certificate of Registration with the Bureau of Internal Revenue can no
longer be located;
3. That despite diligent search and efforts exerted to locate the Certificate of
Registration of Misamis University Domestic Carrier, I could not find the
same such that I now have reasons to believe that it is now lost and cannot
be recover;
4. That said Certificate of Registration is lost without fault of the affiant;
5. As such, I am executing this Affidavit of Loss to attest to the truth of the
foregoing and to support my application for the issuance of a new
Certificate of Registration of Misamis University Domestic Carrier from
the Bureau of Internal Revenue, in lieu of the one that was lost.
IN WITNESS WHEREOF, I have hereunto set my hand this _____________ at
Ozamiz City, Philippines.

KAREN BELINA F. DE LEON

Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, a notary public in and for

Ozamiz City, Clarin and Tudela this ___________________, 2019. Affiant personally
came and appeared with CTC No. 24129354 issued by the Municipal Government of
Kolambugan on Jan. 7, 2019 at Kolambugan, Lanao Del Norte, bearing her signature,
known to me as the same person who personally signed the foregoing instrument before
me and avowed under penalty of law to the whole truth of the contents of said
instrument.