Republic of the Philippines )

Maasin City, Southern Leyte ) S.S.

AFFIDAVIT OF LOSS

KNOW ALL MEN BY THESE PRESENTS:

I, RANDY D. ANIGA of legal age, Filipino, single, and a resident of Brgy. Agbanga
Matalom, Leyte, after having been sworn in accordance with law, hereby depose and
say THAT:

1. I am RANDY D. ANIGA and a holder of the following document, to wit:

 Year 2020 - 2551Q first – fourth quarter

 Year 2020 – 1701Q first – fourth quarter
 1701 ANNUAL INCOME TAX RETURN (ITR)
 Year 2021 2551Q First to Fourth quarter
 Year 2021 – 1701Q first – fourth quarter

2. I have recently discovered that all following documents was already

damaged/lost by Typhoon Oddette last December 16, 2021.

3. This affidavit is executed to attest the truth of the foregoing and for any legal
purpose it may serve.

IN WITNESS WHEREOFF, I have hereunto set my hand this ________ day of January
________, 2022 at Maasin City Southern Leyte Philippines.

RANDY D. ANIGA
Affiant

SUBSCRIBED and SWORN TO before me on the date and at the place indicated below.
The affiant exhibited to me his competent evidence of identity as indicated above.

Signed this at , , Philippines.

WITNESS MY HAND AND SEAL.

Notary Public

Doc. No.
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Book No. I
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