Republic 

of the Philippines)
Province of Masbate) S.S.
City/Municipality of Mandaon

x-----------x
AFFIDAVIT OF LOSS

I, EDNA LUZONG ROMANO, Filipino, of legal age, widow, and a resident of PUROK 1

CABITAN, MANDAON, MASBATE, Philippines, after being duly sworn in accordance
with law, depose and state:

1. That I am the OWNER / REGISTERED PROPREITOR of ROMANO RICEMILL,

located at Purok 1, Cabitan, Mandaon, Masbate, duly organized and existing
under and by virtue of the laws of the Republic of the Philippines;

2. That being registered with the Bureau of Internal Revenue, EDNA L. ROMANO

AND/OR ROMANO RICEMILL has been issued a BIR Certificate of Registration;

3. That sometime in December 2019, the original copy of the said BIR Certificate 

of Registration as well as the corresponding books of accounts, printed
transaction receipts and other related business documents or permits could not
be found or otherwise destroyed which are believed to have been lost due to
typhoon Tisoy;

4. That despite of diligent search and efforts, the same could no longer be found
such that I now believe that it is now lost beyond recovery.

5. As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing

and for whatever legal purposes that this may serve.

IN WITNESS WHEREOF,I have hereunto set my hand this _____________at

MASBATE, Philippines.

EDNA L. ROMANO
AFFIANT

Subscribed and sworn to before me, this ________________at MASBATE CITY, by

affiant, whom I identified through the following competent evidence of identity
_______________issued by_______________, issued on ______________,
personally signed the foregoing instrument before me and vowed under penalty of law
to the whole truth of the contents of said instrument.

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