Republic of the Philippines)

La Trinidad, Benguet) s.s

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AFFIDAVIT OF LOSS

I, Donna W. Angpeo of legal age, marriage, Filipino, and resident of FC-235, Central,
Balili, La Trinidad, Benguet, Philippines, after having been duly sworn to in accordance with
law, do hereby depose and state THAT:

1. The Bureau of Internal Revenue had issued me a Taxpayer’s Identification Number

Card (TIN ID Card) and I had kept it for a longer period of time until it got
lost/missing on March 2020. The facts of the loss are as follows:

Lately, when I transferred my stall from one room to another room of the
same building at Rardas, Km.5, La Trinidad. While I was transferring our
belongings and materials things to another room, including cabinet/drawers
where I kept the aforementioned TIN ID Card, I was of the impression that
the same was still inside the drawer. Thereafter however, when I tried to
locate the said TIN ID Card, purposely to have an ID that I can use for
everyday use, I was surprised to noticed that it was no longer there. I then
realized that the same was missing and nowhere to be found. I therefore
immediately tried to search in the premises but I was unable to find it
despite diligent effort to find.

2. In view of the foregoing, I strongly believed that my said BIR (TIN ID) Card has
been inadvertently lost without any deliberate intent on my part whatsoever.
Therefore, I considered it lost and beyond recovery;

3. I respectfully and earnestly request the Bureau of Internal Revenue (BIR) to issue in
my name another TIN ID Card as a replacement in lieu of the one which was lost;

4. The said TIN ID Card was not confiscated by any Government authorities nor
delivered to any person or entity for the enforcement of civil obligation but due solely
to the afore-cited reason;

5. Finally, I am executing this affidavit to attest to the truthfulness of the foregoing

facts and for all legal intents and purposes it may serve well.

IN WITNESS WHEREOF, I have hereunto set my hand this 16th day of April 2021 at La
Trinidad, Benguet, Philippines.

Donna W. Angpeo
Affiant
Valid ID No. BAL0002539

SUBSCRIBED AND SWORN to before me a Notary Public for and in La Trinidad,

Benguet, Philippines this 16th of April 2021 by the above Affiant personally known to me of her
identity and identified by me to be the same person who personally signed before me the
foregoing Affidavit.

ATTY. CYRUS C. CALAYA

Doc. No. 494; Notary Public until December 31, 2021
Page No. 100; PTR No. BGTCF 6233420; January 4, 2021
Book No. II; IBP Lifetime No. 08051, at Pasig City
Series of 2021; Roll No. 52590, May 12, 2006; Manila
S & B Bldg., FA 224, Km. 4 National, Highway
La Trinidad, Benguet