REPUBLIC OF THE PHILIPPINES}
PROVINCE OF CAVITE } S.S.
MUNICIPALITY OF TANZA }
AFFIDAVIT OF LOSS
(TIN ID)
I, ELJIE D. LAHAY LAHAY, of legal age, Filipino citizen, single and
residing at 113 Barangay Amaya II, Tanza, Cavite, after being sworn in
accordance with law, depose and say that:
1. I am a holder and owner of a Taxpayer Identification Number (TIN)
identification card issued by the BIR Office;
2. Sometime on March, 2019, while I was inside passenger bus within
the Jurisdiction of Municipality of Tanza, Province of Cavite, I
discovered to my shock and disbelief that my wallet along with the
aforesaid identification card is no longer in my possession and missing;
3. I exerted diligent efforts to recover the same but the move proved to be
futile and to no avail;
4. The circumstances leading to the loss of said card have not been
determined;
5. I am executing this affidavit to attest to the foregoing and for the
purpose of reporting the fact of loss of said cards to the Bureau of
Internal Revenue (BIR) Office for the purpose of securing another
cards in lieu of the lost one and for any other legal purpose this may
serve.
AFFIANT FURTHER SAYETH NAUGHT.
IN WITNESS WHEREOF, I have hereunto set my hand this 17th day of April,
2019 in the Municipality of Tanza, Province of Cavite, Philippines.
ELJIE D. LAHAY LAHAY
Affiant
SUBSCRIBED AND SWORN to before me this 17th day of April, 2019 in the
Municipality of Tanza, Province of Cavite, Philippines, affiant exhibiting to me her
PHILHEALTH ID NO: 08-051425950-3 with photograph and signature through
which I had been able to confirm her identity.
ATTY. JASON ALMOND P. DE GUZMAN
Notary Public-Province of Cavite
Commission Expires Dec. 31, 2020
IBP Roll No. 61387
MCLE No. V– 0012037; 12-02-15
PTR No. 1751077; Cavite; 1-07-19
IBP Lifetime Member Roll No: 018800
PPLM; 01-03-18
Doc. No. ____;
Page No. ____;
Book No. ____;
Series of 2019.