REPUBLIC OF THE PHILIPPINES )

QUEZON CITY ) S.S.

AFFIDAVIT OF LOSS

I,JAMES CEDRIC YU ALEGRE, of legal age, Filipino citizen, with address at 10 F.

Sorsogon St. Brgy. Nayong Kanluran, Quezon City, after having been duly sworn to in
accordance with law, hereby depose and state;

That I am the holder/ owner of a CERTIFICATE OF REGISTRATION (ALL DAY

PANDESAL) issued by BIR;

That unfortunately the above item was lost on January 2016 when it was accidentally lost
and despite diligent effort to locate the same but effort found futile;

That I am executing this affidavit in order to attest the truth of the foregoing facts and for
all legal intents it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 15 th day of 2019 at Quezon
City, Philippines.

JAMES CEDRIC YU ALEGRE

Affiant

SUBSCRIBED AND SWORN to before me this 15th day of 2019 at Quezon City,
Philippines. Affiant exhibited to me her CTC/ID No. _______________issued on
____________________ at ________________________.

Doc. No.: _____________ NOTARY PUBLIC

Page No.: _____________
Book No.: _____________
Series of 2019
REPUBLIC OF THE PHILIPPINES )
QUEZON CITY ) S.S.

AFFIDAVIT OF LOSS

I,JAMES CEDRIC YU ALEGRE, of legal age, Filipino citizen, with address at 10 F.

Sorsogon St. Brgy. Nayong Kanluran, Quezon City, after having been duly sworn to in
accordance with law, hereby depose and state;

That I am the holder/ owner of 20 BOOKLETS OFFICIAL RECEIPTS (ALL DAY

PANDESAL) issued by BIR;

That unfortunately the above item was lost on January 2016 when it was accidentally lost
and despite diligent effort to locate the same but effort found futile;

That I am executing this affidavit in order to attest the truth of the foregoing facts and for
all legal intents it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 15 th day of 2019 at Quezon
City, Philippines.

JAMES CEDRIC YU ALEGRE

Affiant

SUBSCRIBED AND SWORN to before me this 15th day of 2019 at Quezon City,
Philippines. Affiant exhibited to me her CTC/ID No. _______________issued on
____________________ at ________________________.

Doc. No.: _____________ NOTARY PUBLIC

Page No.: _____________
Book No.: _____________
Series of 2019