REPUBLIC OF THE PHILIPPINES      )
CITY OF CABANATUAN        ) S.S.
                           AFFIDAVIT OF LOSS
                  OF BIR CERTIFICATE OF REGISTRATION
                                 (COR)
       I, FERNANDO F. FLORA, of legal age, Filipino and a resident of #884 J.P. Rizal
Street Nangka Marikina City, after having been sworn to in accordance with law, hereby
depose and state the following:
      1. That I am the owner of HOMECOURT TRADING located at #884 J.P. Rizal
         St., Nangka Marikina City.
      2. That HOMECOURT TRADING was duly registered with the Bureau of Internal
         Revenue (BIR) with Tax Identification No. 445-438-057-000 and was therefore
         issued a BIR CERTIFICATE OF REGISTRATION (BIR Form 2303);
      3. That unfortunately, the original copy of BIR Certificate of Registration issued
         by the BIR RDO 045 was lost and I took pains to look for the original copy of
         said BIR Certificate of Registration but to no avail;
      4. That I am executing this affidavit to support my request with the Bureau of
         Internal Revenue (BIR) for the reissuance of a new BIR Certificate of
         Registration and for whatever legal purpose it may serve.
      IN WITNESS WHEREOF, I have hereunto set my signature this            day of      ,
2018 at Cabanatuan City.
                                                            FERNANDO F. FLORA
                                                               Affiant
                                                            ID No:
                                                            Issued by:
       SUBSCRIBED AND SWORN to before me at the place and date above stated. I
hereby certify that I personally examined the affiant and am convinced that she
voluntarily executed the foregoing affidavit, read the same and understood its contents.
      WITNESS MY HAND AND NOTARIAL SEAL.
Doc. No.:    ;
Page No.     ;
Book No. ;
Series of 2018;