Republic of the Philippines)

La Trinidad, Benguet) s.s

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AFFIDAVIT OF LOSS

I, Noel Z. Atipen of legal age, single, Filipino, and resident of No. FD-068 C,
Tebteb, 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 for a longer period
of time until it got lost/missing sometime on March 14, 2020. The facts of the
loss are as follows:

Sometime on March 14, 2020, together with my cousins and coworker, we

visit our friend in Ucab, Itogon for a lunch, after that, before we boarded to our
vehicle going back to Balili, La Trinidad, we bought something to eat in the
nearby store for while we are on our way going back home. After we reach our
destination and finally got home, we came out from our vehicle when I checked
my wallet which I put it at the back portion pocket of my pants I noticed that
my wallet was missing. I therefore immediately tried to search in the premises
and even asked my companions about the same but I was unable to find it
despite diligent effort to find.

2. In view of the foregoing, I strongly believed that my said wallet which contain
my 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 Bureau of Internal Revenue (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 July 21, 2020 at La
Trinidad, Benguet, Philippines.

Noel Z. Atipen
Affiant

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

Benguet, Philippines this July 21, 2020 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.

ATTY. CYRUS C. CALAYA

Doc. No. 170; Notary Public until December 31, 2021
Page No. 34; PTR No. BGTCF 6232438; January 10, 2020
Book No. I; IBP Lifetime No. 08051, at Pasig City
Series of 2020; Roll No. 52590, May 12, 2006; Manila
S & B Bldg., FA 224, Km. 4 National, Highway
La Trinidad, Benguet