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SIR:
R.F. (PENALTIES)
01-2023 P 1,194.86
01-2022 P 1,194.86
01-2021 P 1,194.86
01-2020 P 1,194.86
01-2011 P 1,194.86
- P 6,574.64
NIRI - P 1,000.00
NO BOOKS - P 1,000.00
LOST RECIPTS - P 1,000.00
LOST ATP - P 1,000.00
LOST COR - P 1,000.00 P 5,000
PM 10-31-2012 P 1,132.13
10-30-2012 P 1447.09
10-30-2013 P 1449.41
10-30-2013 P 1479.91
10-30-2014 P 911.11 P 6,469.65
P 18,044.29
Gumagalang,
Renalyn C. Pecson
Tin No. 246-444-060-000
#12 Ilang-Ilang St. Payatas A Q.C.
CP #
1. That as a duly registered proprietor I was issued and has registered the
following:
2. That, I have recently discovered that the above items are irretrievably loss
and nowhere to be found;
3. That, I exerted diligent effort to retrieve nor recover but my efforts prove
futile, so I consider the same as irretrievably lost or destroyed;
4. That, this affidavit was executed to attest the truth of the foregoing facts,
RENALYN C. PECSON
Affiant/Principal
NOTARY PUBLIC