Republic of the Philippines )

Dumaguete City ) S.S.

x------------------------------------------------x

AFFIDAVIT OF LOSS
I, LYN S. PIALAGO, of legal age, Filipino, married, and a resident of Jilocon, San Jose,
Negros Oriental, after having been duly sworn to in accordance with law, do hereby depose and
state THAT:

1. I am a holder of a Tax Identification Number (TIN) Card with No. 258-578-102-000

issued by the Bureau of Internal Revenue (BIR), Mandaue City;

2. Sometime on March, 2018, I lost the abovementioned TIN Card;

3. That despite diligent search and efforts to locate the said TIN Card, I could not find it
such that I now believe that it is lost beyond recovery;

4. Such TIN Card was not confiscated by any government authority;

5. As such, I am executing this Affidavit of Loss to attest, confirm and declare the truth of
the foregoing, to support my application for the reissuance of a new TIN Card in lieu of
the lost one, and for whatever legal purposes this may serve best.

IN WITNESS WHEREOF, I have hereunto set my hand this 3 rd day of June, 2020 at
Dumaguete City, Philippines.

LYN S. PIALAGO
Affiant
Identification Card: DepED-NegOr Division I.D.
Identification Card Number: 459 3096

ACKNOWLEDGMENT
SUBSCRIBED and SWORN to before me this 3rd day of June, 2020, personally
appeared Affiant who is known to me and identified by me by competent evidence of identity in
accordance with the 2004 Rules on Notarial Practice, who exhibited to me the above
identification card, who executed this foregoing Affidavit of Loss and acknowledged that the
same is her free and voluntary act and deed. This instrument consisting of one page, including
this page whereon this Acknowledgement is written has been signed by Affiant.

IN WITNESS WHEREOF, I have hereunto affixed my signature and notarial seal this 3rd
day of June, 2020 in Dumaguete City, Philippines.

Doc. No._____
Page No.____
Book No. ____
Series 2020.