REPUBLIC OF THE PHILIPPINES )

Province of Davao del Norte )

City of Tagum )S.S
x-------------------------x

AFFIDAVIT OF LOSS

I, ROY CONRAD T. CALZEDA, Filipino, married, of legal age and a

resident of Prk. Castrence , Tagum City, Davao del Norte, Philippines, after
having been duly sworn to in accordance with the law, do hereby depose
and say;

1. That I am a holder/owner/ possessor of an TIN Identification Card issued

by Bureau of Internal Revenue at Tagum City duly issued bearing
number 421-430-659-000;

2. That I discovered that the said TIN Identification Card was no longer
found in my bag;

3. Despite diligent efforts to locate the said TIN Identification Card, the same
were proven futile;

4. I am executing this Affidavit to attest to the truth and veracity of the

foregoing statements and to apprise the proper authorities concerned
on the matter for their information, guidance and for whatever legal
purpose/s this may serve best.

IN WITNESS WHEREOF, I have hereunto set my hand this____ day of

__________________ at _________________________, Philippines.

ROY CONRAD T. CALZEDA

Affiant

SUBSCRIBED AND SWORN to before me this _____ day of

________________________at ________________________, Philippines.

Doc. No. ____

Page No. ____;
Book No. ____;
Series of ____.