Republic of the Philippines)

Province of Leyte ) s.s.

CITY OF TACLOBAN )
x--------------------------------x

AFFIDAVIT OF LOSS

That HERMOGENES A. TIMOLA JR, of legal age, Filipino, and a resident

of Brgy. 33, Paterno St., Tacloban City, after having been duly sworn to in
accordance with law hereby depose and say;

1. That I am a proprietor of HIGHNESS PENSIONE 9 SUITES with

business address at 174 Paterno St., Tacloban City;

2. That as such I was issued a Mayor’s Business Permit by the City

Mayor’s Office, Tacloban City;

3. That after the onslaught of the super typhoon Yolanda that hit the
region, I decided to close its operation thereafter it resume its operation on
January 01, 2015 up to present;

4. That however, all of my several important personal and business

related documents such as but not limited to, Certificate of Registration,
Official Receipts, Sales Invoice, Delivery Receipt, Ask for Receipts, DTI, Mayor’s
Permit were lost and destroyed considering the degree of devastation, retrieval
of the above-mentioned documents were impossible.

5. That I am executing this to attest to the truth and the veracity of all
my foregoing statements for whatever legal purposes this may serve.

IN WITNESS WHEREOF, I have hereunto affix my signature this

_________________at Tacloban City.

ANTHONY ASEO ACLO

Affiant

SUBSCRIBED AND SWORN to before me this _________________ at

Tacloban City.

Doc. No. ____

Page No. ____
Book No. ____
Series of 2019