Republic of the Philippines}

In the City of Pagadian. . . }S.S.

X-------------------/

AFFIDAVIT OF LOSS

KNOW ALL MEN BY THESE PRESENTS:

I, YOLANDA CORTINA MOSQUEDA, of legal age, married, Filipino, and

a resident of Barangay Militar, Tukuran, Zamboanga del Sur, after having
sworn to an oath, hereby depose and state:

1. That I am the owner/possessor of the following documents:

a. Fire Clearance,
b. Business Permit,
c. Brngy. Cedula, and
d. SSS Receipt;
e. Brngy. Clearance;

2. That sometime in March 13, 2020, those documents were lost and its
whereabouts cannot be ascertained despite due and diligent search made
and undertaken;

3. That I exerted diligent effort in locating the aforementioned documents,

but to no avail;

4. As such, I am executing this affidavit to attest to the veracity of the

foregoing information and to support my application for the issuance of a
new Business Permit, in lieu of the one that was lost;

IN WITNESS WHEREOF, I hereby affix my signature this 20 th day of

May, 2020, at Pagadian City, Philippines.

YOLANDA CORTINA MOSQUEDA

Affiant

SUBSCRIBED AND SWORN TO before me, this 20th day of May, 2020,
and the affiant presented her ID bearing her signature and photograph, with
the specifics above-stated, and she affirmed to me that she understood the
contents thereof.
Doc. No. _________
Page No.: ________
Book No. ________
Series of 2020.