AFFIDAVIT OF LOSS

I, ____________________________, of legal age, Filipino, single/married, and resident of

___________________________________________________, after being duly sworn
according to law, hereby depose and state that:

1. I am the holder of a Job Order document with J.O. number 0002019 for request of
Authority to Print from BIR Paranaque issued by Leonard Prints Inc., Las Pinas City
last September 28, 2016.
2. Sometime in September 29, 2016 I lost the above
Job Order document with J.O. number 0002019 under the following circumstances:
The document could have been left in the BIR Office in Paranaque.
3. Despite diligent efforts exerted, I could no longer locate, find or recover the said
Job Order document with J.O. number 0002019 and to the best of my knowledge,
the same is truly lost.
4. The said Job Order document with J.O. number 0002019 has not been confiscated
by any officer of the law or the issuing office or agency due to the violation of any
law, statute, order, rule or regulation.
5. In the event that the lost Job Order document with J.O. number 0002019 should
hereafter be found or located, I undertake to forward or surrender the same to
Leonard Prints Inc., Las Pinas City for appropriate disposal.
6. I am executing this Affidavit to attest to the truth of the foregoing statements
and to request the issuance of a new Job Order document in lieu of the one which
was lost.
AFFIANT FURTHER SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto set my hand this ____________________ at

_________________________.

[Signature above Printed Name of Affiant]

Affiant

SUBSCRIBED AND SWORN to before me this ____________________, affiant exhibited to

me
his/her Competent Evidence of Identity by way of __________________ issued at
______________ on
__________________.
Doc. No. ______;
Page No. ______;
Book No. ______;

Series of ______