REPUBLIC OF THE PHILIPPINES )

CITY OF LAOAG ) s.s.

AFFIDAVIT OF LOSS

I, CYNTHIA A. CACACTIN, of legal age, Filipino and a resident of

Brgy. 15, Bacarra, Ilocos Norte, Philippines, after having been duly sworn
to in accordance with law hereby voluntarily depose and state: That-

1. I am a holder of a Tax Identification Number (TIN) Card issued

by the Bureau of Internal Revenue(BIR) bearing TIN 167-517-
656;

2. I always keep the said TIN Card in my wallet;

3. On June 25-28, 2018, I attended a seminar held in Manila,

Philippines;

4. While in Manila, I rode a taxi cab going to the venue for the
said seminar;

5. When I arrived inside the venue, I noticed that my wallet

containing the said TIN Card was already lost and nowhere to
be found inside my bag;

6. I exerted diligent effort to locate my wallet but to no avail.

Hence, my wallet, containing the said TIN Card, is now
deemed lost;

7. I am executing this affidavit to attest to the truth of the

foregoing facts and hereby ask the BIR to issue me
replacement for my TIN Card in lieu of the lost one.

IN WITNESS WHEREOF I have hereunto set my hand this 3 rd day

of September 2018 at Laoag City, Philippines.

CYNTHIA A. CACACTIN
Affiant

SUBSCRIBED AND SWORN to before me this 3rd day of

September 2018 at Laoag City, Philippines. Affiant is personally known
to me and acknowledged to me that the foregoing is her voluntary act
and deed.