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Republic of the Philippines)

Province of Eastern Samar) S.S.


City of Borongan )
x----------------------------x
__________________________________________________________________

AFFIDAVIT OF LOSS

I, ELENA JOY L. YOHANON, of legal age, married, and residing at Brgy.


Alang-Alang, Borongan City, Eastern Samar, after having been duly sworn to in
accordance to law hereby depose and say;

That I am a holder of Tax Identification Card bearing No. 275-805-238-000


issued to me by the BIR;

That said TIN Card was lost on September 2022 and despite all efforts in
trying to locate same could not be found;

That this affidavit is being executed to attest to the truth of the foregoing
stated fact and for all legal intent and purposes;

IN WITNESS WHEREOF, I have hereunto set my hand this 5th day of


January 2023 at Borongan City, Province of Eastern Samar, Philippines.

ELENA JOY L. YOHANON


Affiant

SUBSCRIBED AND SWORN to before me this 5th day of January 2023,


at Borongan City, Province of Eastern Samar, Philippines. Affiant’s exhibiting her
Company Card bearing No. AMSC-040615-0021 with her photograph thereon.

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