Affidavit of Loss DTI Certificate of Registration

Republic of the Philippines)

Province of ____________________)S.S.
City/Municipality of _____________)
x - - - - - - - - - - - - - x

AFFIDAVIT OF LOSS

I, _____________, Filipino, of legal age, (single / married /

widow), and a resident of _____________, Philippines, after being
duly sworn in accordance with law, depose and state:

That I am an Owner of the business name "_____________" which is

registered with the Department of Trade and Industry (DTI)
pursuant to the provisions of Act 3883, as amended by Act 4147
and RA 863;

That I was issued a Certificate of Business Name Registration on

_____________ with No. _____________ which is valid from
_____________ to _____________;

That recently, when we looked for the original copy of the said
DTI Certificate Business Name Registration, the same could not be
found and must have been misplaced and that despite of diligent
search and efforts, the same could no longer be found such that I
now believe that it is now lost beyond recovery;

As such, I am executing this Affidavit of Loss to attest to the

truth of the foregoing and for whatever legal purposes that this
Affidavit may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this

_____________ at _____________, Philippines.

AFFIANT

(JURAT)