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Affidavit of Loss

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REPUBLIC OF THE PHILIPPINES )

CALOOCAN CITY ) S.S.

AFFIDAVIT OF LOSS

I, __________________, of legal age, married, Filipino citizen, with postal address


at 26E. Aberdeen St., Brgy. Bahay Toro, Quezon City, after having been sworn in accordance
with law, depose and say:

1. I am the Proprietress of Samahan Traders which is primarily engaged in


Fabrication and with business address at 106 Caimito Road, cor. Samson Road, Caloocan City;

2. That the said Samahan Traders have filed for Business Closure last January 2014
and accordingly submitted all original documents in compliance with the requirements of the
Business Permit and Licensing Office (BPLO), including but not limited to the following:

a) Original Mayor’s Permit


b) Original Official Receipt
c) Sketch Map of business
d) Notarized Letter of Closure

3. That series of follow up were made by my authorized representative regarding the


approval of the business closure until such time I personally did the follow up in order to know if
there are other requirements that are lacking;

4. That upon inquiring with the BPLO, I was informed that the records I submitted
can no longer be located or were missing;

5. Despite diligent search, the aforementioned documents cannot be found and it is


possible that the same is now considered lost and beyond recovery;

6. As such, I am executing this Affidavit to attest to the truth of the foregoing facts
and for any other legal purpose that this Affidavit may serve.

IN WITNESS WHEREOF, we have hereunto set our hands this _____ day of
_________, in Caloocan City, Philippines.

_______________
I.D. No. DL No. N03-94-171355
Date Issued: 9 September 2016

SUBSCRIBED AND SWORN, to before me this ____ of ___________at Caloocan


City, Philippines. Affiants personally exhibited to me their above-mentioned valid government
issued identification Card bearing his picture and genuine signature as competent evidence of
the Affiant’s identity in accordance with the 2004 Rules on Notarial Practice.

Doc. No. _____


Page No. _____
Book No. _____
Series of 2017

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