REPUBLIC OF THE PHILIPPINES ) CITY

OF ________________ ) S.S.

AFFIDAVIT OF LOSS
OF BIR CERTIFICATE OF REGISTRATION
(COR)

I, ____________________, of legal age, Filipino and a resident of

____________________________________________________________, after having
been sworn to in accordance with law, hereby depose and state the following:

1. That I am the owner of ____________________ located at

____________________________________________________________.

2. That ____________________ was duly registered with the Bureau of Internal

Revenue (BIR) with Tax Identification No. ____________________and was
therefore issued a BIR CERTIFICATE OF REGISTRATION (BIR Form 2303);

3. That unfortunately, the original copy of BIR Certificate of Registration issued by the
BIR RDO __________ was lost and I took pains to look for the original copy of said
BIR Certificate of Registration but to no avail;

4. That I am executing this affidavit to support my request with the Bureau of Internal
Revenue (BIR) for the reissuance of a new BIR Certificate of Registration and for
whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my signature this day of , 20__ at

_______________.

_______________________
Affiant
ID No:
Issued by:

SUBSCRIBED AND SWORN to before me at the place and date above stated. I hereby
certify that I personally examined the affiant and am convinced that she voluntarily executed the
foregoing affidavit, read the same and understood its contents.

WITNESS MY HAND AND NOTARIAL SEAL.

Doc. No.: ;
Page No. ;
Book No. ;
Series of 20__;