REPUBLIC OF THE PHILIPPINES)
MUNTINLUPA CITY            ) S. S.
                                    AFFIDAVIT OF LOSS
       I, _______________________________, of legal age, Filipino, single/married, and a
resident of __________________________________________, after being duly sworn to in
accordance with law depose and say:
      1. That a Certificate of Registration was issued under my name by the Bureau of
         Internal Revenue (BIR);
      2. That I use to keep the said Certificate of Registration in my files for convenience and
         safety purposes;
      3. That on ___________________, when I was about to use the said CR, I discovered
         that it was already lost/missing;
      4. That diligent effort was already exerted to locate the said CR but all effort proved
         futile and the same could no longer be found;
      5. That I believe they are now beyond recovery;
      6. That I am executing this affidavit to attest to the truth of the foregoing facts and for
         the purpose of reporting the loss and for whatever legal purpose/s this may serve.
      IN WITNESS HEREOF, I am affixing my signature this _____________________ at
Muntinlupa City.
                                             ______________________________
                                                  Affiant
                                             ________ I.D. No. ______________
       SUBSCRIBED AND SWORN to before me this ________________ at Muntinlupa
City. Affiant exhibited to me his/her Competent Evidence of Identity abovementioned.