Republic of the Philippines)

La Trinidad, Benguet) s.s

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AFFIDAVIT OF LOSS

I, OMAR SACLA PALA-OG of legal age, single, Filipino, and resident of No.
FD135B Pines Park, Balili, La Trinidad, Benguet, Philippines, after having been duly
sworn to in accordance with law, do hereby depose and state THAT:

1. The Bureau of Internal Revenue had issued me a Taxpayer’s Identification

Number Card (TIN ID Card) and I had kept it in my wallet but I am no longer in
my possession of the same because of the foregoing facts:

On July 2, 2020, together with my older brother we bought concrete bricks

at a nearby establishment here in La Trinidad, Benguet in which we parked our
vehicle beside the National Road. We left our sling bag inside at the front
portion of the vehicle, after which we left the vehicle unlock and we went to load
the said concrete brick at the back of our vehicle. After loading the said
concrete bricks, we noticed that our sling bag which we left inside at the front
portion of our vehicle was already missing. Said sling bag contains two (2)
wallets, cellphone charger and cash amounting to One Hundred Nineteen
Thousand Pesos (Php 119,000.00). I notice that my wallet was also missing
which contains my Driver’s License, TIN Card, BDO ATM and cash worth Six
Thousand Pesos (Php 6,000.00) also my older brother’s wallet was missing
which contains important things and cash.

2. I therefore immediately tried to search the same but I was unable to find it. In
view of the foregoing, I strongly believed that my said BIR TIN ID Card has
been inadvertently lost without any deliberate intent on my part whatsoever.
Therefore, I considered it lost and beyond recovery ;

3. I respectfully and earnestly request the BIR to issue in my name another TIN
ID Card as a replacement in lieu of the one which was lost;

4. The said TIN ID Card was not confiscated by any Government authorities nor
delivered to any person or entity for the enforcement of civil obligation but due
solely to the afore-cited reason;

5. Finally, I am executing this affidavit to attest to the truthfulness of the

foregoing facts and for all legal intents and purposes it may serve well.

IN WITNESS WHEREOF, I have hereunto set my hand this __________ at La

Trinidad, Benguet, Philippines.

OMAR SACLA. PALA-OG

Affiant

SUBSCRIBED AND SWORN to before me a Notary Public for and in La Trinidad,

Benguet, Philippines this ________________by the above Affiant personally known to me of his
identity and identified by me to be the same person who personally signed before me the
foregoing Affidavit.