REPUBLIC OF THE PHILIPPINES      )
CITY OF CABANATUAN        ) S.S.
                         AFFIDAVIT OF LOSS
              OF BIR CERTIFICATE OF REGISTRATION (COR)
      I, LEAH RIVERA JACOBE, of legal age, Filipino and a resident of #563 Purok 3,
Provincial Road, Brgy. Bucot (In front of Sinchioco Calibration), Aliaga, Nueva Ecija, after
having been sworn to in accordance with law, hereby depose and state the following:
       1. That I am the owner of R.L.J. ALUMINUM WORKS located at #563 Purok 3,
          Provincial Road, Brgy. Bucot (In front of Sinchioco Calibration), Aliaga, Nueva
          Ecija;
       2. That R.L.J. ALUMINUM WORKS was duly registered with the Bureau of
          Internal Revenue (BIR) with Tax Identification No. 702-407-940-000 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 23A 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.
                                                               LEAH RIVERA JACOBE
                                                                  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;