REPUBLIC OF THE PHILIPPINES

__________ City S.S.

AFFIDAVIT OF LOSS

I, STATE NAME OF AFFIANT, of legal age, Filipino, and with office address at AIM
Building, 123 Paseo de Roxas, Makati City, after having been sworn in accordance with law,
hereby depose and state that:

1. I am the state position of authorized representative of _______________________., a

corporation duly organized and existing under the laws of the Philippines, and is the
authorized signatory in all the company’s transactions with the Bureau of Internal Revenue
(BIR);

2. I have authorized the law firm ________________________________ or any of its

partners, associates, or members, which has office address at the 17 th Floor Robinsons Equitable
Tower, No. 4 ADB Avenue corner Poveda Drive, Ortigas Center, Pasig City, to apply for,
present, and submit the requirements and to do all other acts as may be necessary for the
dissolution of the company;

3. After exerting due diligence and efforts to locate the original official receipts, which
is being required by ___________________ for the dissolution of the company, I was not able to
find the company’s copy of said documents. The fact that the last official receipt was issued
many years ago and there was no proper turnover of the company records, made it hard for
me to recall where the official receipts were kept and whether these were already destroyed or
inadvertently disposed of;

4. This affidavit is being executed to attest to the veracity of the statements given above
relative to the abovementioned document as well as for any other legal purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of ________ 2018
in ________ City.

STATE NAME OF AUTHORIZED

REPRESENTATIVE
Affiant

SUBSCRIBED AND SWORN to before me this ______ day of ___________________ in

__________________ City, affiant exhibited to me his/her __________________________ issued in
_________________________.

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of 2018.
REPUBLIC OF THE PHILIPPINES
__________ City S.S.

AFFIDAVIT OF LOSS

I, STATE NAME OF AFFIANT, of legal age, Filipino, and with office address at AIM
Building, 123 Paseo de Roxas, Makati City, after having been sworn in accordance with law,
hereby depose and state that:

1. I am the state position of authorized representative of _______________________., a

corporation duly organized and existing under the laws of the Philippines, and is the
authorized signatory in all the company’s transactions with the Bureau of Internal
Revenue (BIR);

2. I have authorized the law firm ________________________________ or any of its

partners, associates, or members, which has office address at the 17 th Floor Robinsons Equitable
Tower, No. 4 ADB Avenue corner Poveda Drive, Ortigas Center, Pasig City, to apply for,
present, and submit the requirements and to do all other acts as may be necessary for the
dissolution of the company;

3. After exerting due diligence and efforts to locate the original official receipts, which
is being required by ___________________ for the dissolution of the company, I was not able to
find the company’s copy of said documents. The fact that the last official receipt was issued
many years ago and there was no proper turnover of the company records, made it hard for
me to recall where the official receipts were kept and whether these were already destroyed or
inadvertently disposed of;

4. This affidavit is being executed to attest to the veracity of the statements given above
relative to the abovementioned document as well as for any other legal purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of ________ 2018
in ________ City.

STATE NAME OF AUTHORIZED

REPRESENTATIVE
Affiant

SUBSCRIBED AND SWORN to before me this ______ day of ___________________ in

__________________ City, affiant exhibited to me his/her __________________________ issued in
_________________________.

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of 2018.
REPUBLIC OF THE PHILIPPINES
__________ City S.S.

AFFIDAVIT OF LOSS

I, STATE NAME OF AFFIANT, of legal age, Filipino, and with office address at AIM
Building, 123 Paseo de Roxas, Makati City, after having been sworn in accordance with law,
hereby depose and state that:

1. I am the state position of authorized representative of _______________________., a

corporation duly organized and existing under the laws of the Philippines, and is the
authorized signatory in all the company’s transactions with the Bureau of Internal
Revenue (BIR);

2. I have authorized the law firm ________________________________ or any of its

partners, associates, or members, which has office address at the 17 th Floor Robinsons Equitable
Tower, No. 4 ADB Avenue corner Poveda Drive, Ortigas Center, Pasig City, to apply for,
present, and submit the requirements and to do all other acts as may be necessary for the
dissolution of the company;

3. After exerting due diligence and efforts to locate the original official receipts, which
is being required by ___________________ for the dissolution of the company, I was not able to
find the company’s copy of said documents. The fact that the last official receipt was issued
many years ago and there was no proper turnover of the company records, made it hard for
me to recall where the official receipts were kept and whether these were already destroyed or
inadvertently disposed of;

4. This affidavit is being executed to attest to the veracity of the statements given above
relative to the abovementioned document as well as for any other legal purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of ________ 2018
in ________ City.

STATE NAME OF AUTHORIZED

REPRESENTATIVE
Affiant

SUBSCRIBED AND SWORN to before me this ______ day of ___________________ in

__________________ City, affiant exhibited to me his/her __________________________ issued in
_________________________.

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of 2018.
REPUBLIC OF THE PHILIPPINES
__________ City S.S.

AFFIDAVIT OF LOSS

I, STATE NAME OF AFFIANT, of legal age, Filipino, and with office address at AIM
Building, 123 Paseo de Roxas, Makati City, after having been sworn in accordance with law,
hereby depose and state that:

1. I am the state position of authorized representative of _______________________., a

corporation duly organized and existing under the laws of the Philippines, and is the
authorized signatory in all the company’s transactions with the Bureau of Internal
Revenue (BIR);

2. I have authorized the law firm ________________________________ or any of its

partners, associates, or members, which has office address at the 17 th Floor Robinsons Equitable
Tower, No. 4 ADB Avenue corner Poveda Drive, Ortigas Center, Pasig City, to apply for,
present, and submit the requirements and to do all other acts as may be necessary for the
dissolution of the company;

3. After exerting due diligence and efforts to locate the original official receipts, which
is being required by ___________________ for the dissolution of the company, I was not able to
find the company’s copy of said documents. The fact that the last official receipt was issued
many years ago and there was no proper turnover of the company records, made it hard for
me to recall where the official receipts were kept and whether these were already destroyed or
inadvertently disposed of;

4. This affidavit is being executed to attest to the veracity of the statements given above
relative to the abovementioned document as well as for any other legal purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of ________ 2018
in ________ City.

STATE NAME OF AUTHORIZED

REPRESENTATIVE
Affiant

SUBSCRIBED AND SWORN to before me this ______ day of ___________________ in

__________________ City, affiant exhibited to me his/her __________________________ issued in
_________________________.

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of 2018.
REPUBLIC OF THE PHILIPPINES
__________ City S.S.

AFFIDAVIT OF LOSS

I, STATE NAME OF AFFIANT, of legal age, Filipino, and with office address at AIM
Building, 123 Paseo de Roxas, Makati City, after having been sworn in accordance with law,
hereby depose and state that:

1. I am the state position of authorized representative of _______________________., a

corporation duly organized and existing under the laws of the Philippines, and is the
authorized signatory in all the company’s transactions with the Bureau of Internal
Revenue (BIR);

2. I have authorized the law firm ________________________________ or any of its

partners, associates, or members, which has office address at the 17 th Floor Robinsons Equitable
Tower, No. 4 ADB Avenue corner Poveda Drive, Ortigas Center, Pasig City, to apply for,
present, and submit the requirements and to do all other acts as may be necessary for the
dissolution of the company;

3. After exerting due diligence and efforts to locate the original official receipts, which
is being required by ___________________ for the dissolution of the company, I was not able to
find the company’s copy of said documents. The fact that the last official receipt was issued
many years ago and there was no proper turnover of the company records, made it hard for
me to recall where the official receipts were kept and whether these were already destroyed or
inadvertently disposed of;

4. This affidavit is being executed to attest to the veracity of the statements given above
relative to the abovementioned document as well as for any other legal purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of ________ 2018
in ________ City.

STATE NAME OF AUTHORIZED

REPRESENTATIVE
Affiant

SUBSCRIBED AND SWORN to before me this ______ day of ___________________ in

__________________ City, affiant exhibited to me his/her __________________________ issued in
_________________________.

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of 2018.
REPUBLIC OF THE PHILIPPINES
__________ City S.S.

AFFIDAVIT OF LOSS

I, STATE NAME OF AFFIANT, of legal age, Filipino, and with office address at AIM
Building, 123 Paseo de Roxas, Makati City, after having been sworn in accordance with law,
hereby depose and state that:

1. I am the state position of authorized representative of _______________________., a

corporation duly organized and existing under the laws of the Philippines, and is the
authorized signatory in all the company’s transactions with the Bureau of Internal
Revenue (BIR);

2. I have authorized the law firm ________________________________ or any of its

partners, associates, or members, which has office address at the 17 th Floor Robinsons Equitable
Tower, No. 4 ADB Avenue corner Poveda Drive, Ortigas Center, Pasig City, to apply for,
present, and submit the requirements and to do all other acts as may be necessary for the
dissolution of the company;

3. After exerting due diligence and efforts to locate the original official receipts, which
is being required by ___________________ for the dissolution of the company, I was not able to
find the company’s copy of said documents. The fact that the last official receipt was issued
many years ago and there was no proper turnover of the company records, made it hard for
me to recall where the official receipts were kept and whether these were already destroyed or
inadvertently disposed of;

4. This affidavit is being executed to attest to the veracity of the statements given above
relative to the abovementioned document as well as for any other legal purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of ________ 2018
in ________ City.

STATE NAME OF AUTHORIZED

REPRESENTATIVE
Affiant

SUBSCRIBED AND SWORN to before me this ______ day of ___________________ in

__________________ City, affiant exhibited to me his/her __________________________ issued in
_________________________.

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of 2018.