REPUBLIC OF THE PHILIPPINES )

PROVINCE OF QUIRINO ) S.S.

MADDELA/NAGTIPUNAN )

AFFIDAVIT OF LOSS

I, CHARLIE BOY ALAMAN TORIO, of legal age, Filipino citizen, single and with
residence address at Pedlisan, Maddela, Quirino, after having been duly sworn to in
accordance with law do hereby depose and say the following to wit that:

1. I applied for Tax identification number at the Bureau of Internal Revenue (BIR)-
Cabarroguis, Quirino, in which I filled up a BIR Form 1904 and later on given back
with my personal TIN;

2. However, on the day that I need the said document, it was not in my cabinet
where I usually put all my pertinent documents, beyond recovery
notwithstanding, diligent efforts to locate the same to no avail;

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

foregoing and for whatever legal purposes that this Affidavit may serve.

I FURTHER SAYETH NONE.

IN WITNESS WHEREOF, I have hereunto set my hand this 27th day of September 2022
at Maddela, Quirino, Philippines.

CHARLIE BOY ALAMAN TORIO

Affiant
DL No. B07-21-200779, valid until 2025/08/21

SUBSCRIBED AND SWORN to before me this 27th day of September 2022 at Maddela,
Quirino.

WITNESS MY HAND AND SEAL.

Doc. No. 268;

Page No. 55;
Book No. 20;
ATTY. JUNARD N. RAMOS
Series of 2022. NOTARY PUBLIC
MADDELA-NAGTIPUNAN
LAWYER ROLL NO. 52289
PTR NO. 7606601/01-02-2022/MADDELA
IBP NO. 184708/02-17-2022/QUIRINO CHAPTER
MCLE COMPLIANCE NO. VI 12943 09-27-18
ADMIN. MATTER NO.2022-02/UNTIL DECEMBER 31, 2023
POBLACION NORTE, MADDELA, QUIRINO