REPUBLIC OF THE PHILIPPINES)

___________________) S.S.

AFFIDAVIT OF LOSS

That I, Ricnarcis Casilac Enrile of legal age, Filipino citizen and single with residence
and postal address at Pindasan, Mabini, Davao de Oro after having duly
sworn to in accordance with the law do hereby depose and say:

1. That I am a holder of TIN Card with No. 275 – 949 – 026 – 000 issued by Bureau of
Internal Revenue [BIR] RDO 113, Davao City;

2. That the aforesaid TIN Card was lost due to unavoidable circumstances when it was
unfortunately misplaced;

3. That despite of diligent effort has been made to look for the said item mentioned
above but proved futile and must therefore considered it lost for all intents and
purposes.

That I am executing this affidavit to attest to the truth of foregoing facts and to
inform the proper authorities concern and for whatever legal purpose this affidavit may
serve. IN WITNESS WHEREOF, I hereunto set my hand on this ___ day of ________, 20__, in
the City of _______.

Ricnarcis Casilac Enrile

Affiant

SUBSCRIBED AND SWORN to before me on this this ___ day of _____ 20__, in the City
of _______.

Doc. No._____
Page No._____
Book No.______
Series of_______