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Affidavit of Loss

Cristy Jay A. Diaz, a resident of Samar, Philippines, has executed an affidavit to report the loss of her Certificate of Registration (COR) with the Bureau of Internal Revenue (BIR). She intends to use this affidavit to secure a Tax Clearance and process the closure of her BIR registration under her maiden name, as well as to comply with requirements for new employment. Despite having a photocopy, she cannot locate the original document, which may have been lost during her employment reassignment.

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Cristy Jay A. Diaz
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14 views2 pages

Affidavit of Loss

Cristy Jay A. Diaz, a resident of Samar, Philippines, has executed an affidavit to report the loss of her Certificate of Registration (COR) with the Bureau of Internal Revenue (BIR). She intends to use this affidavit to secure a Tax Clearance and process the closure of her BIR registration under her maiden name, as well as to comply with requirements for new employment. Despite having a photocopy, she cannot locate the original document, which may have been lost during her employment reassignment.

Uploaded by

Cristy Jay A. Diaz
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Republic Of The Philippines )

Province of Samar ) s.s

AFFIDAVIT OF LOSS

I, Cristy Jay A. Diaz, of legal age, a Filipino citizen, and a


resident of City Homes Subdivision, Brgy. Tagbayaon,
Jiabong, Samar, 6701, after having been duly sworn in
accordance with law, do hereby depose and state:

1. That I am the same person registered with the Bureau


of Internal Revenue (BIR) under my maiden name
Cristy Jay Cabadsan Abogadie, with TIN No. 410-
673-836-000, and holder of a Certificate of
Registration (COR) bearing OCN
2RC0001134769;

2. That I am executing this affidavit to report the loss of


the original copy of the said Certificate of
Registration (COR);

3. That I still retain a photocopy of the aforementioned


COR, but despite diligent efforts, I can no longer locate
the original document;

4. That the original may have been lost during my


reassignment to different areas in region VIII while
employed with DSWD KALAHI CIDSS;

5. That I am executing this affidavit to:

a) Secure a Tax Clearance and process the closure


of my existing BIR registration under my maiden
name;

b) Comply with the requirements for the filing and


processing of BIR Form 1902 for new employment
or registration;

6. That this affidavit is executed to attest to the truth of


the foregoing facts and to comply with any BIR
requirements as it is a required supporting document
for the Tax Clearance and Closure process, and for
whatever legal or administrative purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this


___ day of _______, 2025 at Catbalogan City, Samar,
Philippines.

CRISTY JAY A. DIAZ


Affiant

SUBSCRIBED AND SWORN to before me this ___ day of


________, 2025 at Catbalogan City, Samar, affiant exhibiting
to me her valid government-issued ID with the following
details:

ID Type: Unified Multi-Purpose ID


ID Number: CRN-0113-0785279-8

Notary Public
Doc. No. _____;
Page No. _____;
Book No. __;
Series of 2025.

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