REPUBLIC OF THE PHILIPPINES)

CITY OF MANILA ) S.S.

AFFIDAVIT OF LOSS

I, JUAN DELA CRUZ, of legal age, single, Filipino, with residence at

San Jose St. Brgy 54, Sampaloc, Manila, after having been sworn to in
accordance with law hereby depose and say that:

1. I am a holder of Tax Identification Number (TIN) ID 123456789,

issued by BIR Revenue District No. 38 in Intramuros, Manila.

2. On 01 September 2020, while my motorcycle was parked outside our

office, an unidentified person forcedly, and without my knowledge and
consent, opened the U Box of my motorcycle.

3. The unidentified person took my wallet that contains all my valuable

items including my TIN ID.

4. I took earnest efforts to locate the person and asked the authorities,
but to no avail.

5. I execute this affidavit to attest the truthfulness and veracity of the

foregoing facts, and for the purpose of securing another TIN ID in
place of the stolen one, and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto signed my name this

_____th day of September 2020, in Manila, Philippines.

        JUAN DELA CRUZ

Affiant                         
        
 
      SUBSCRIBED AND SWORN to before me this _____ day of
September 2020 in Quezon City Philippines. Affiant exhibited to me his
competent evidence of identity as __________________.

Notary Public
Doc. No____;
Page No. ___;
Book No. ___;
Series of 2020.