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Affidavit of Loss - Printer's Certificate of - Dungca, Rebecca

Rebecca Dungca executed an affidavit of loss stating that: 1) She is the owner of BI-SY EAT RESTAURANT and has lost her Printer's Certificate of Delivery of Receipts/Invoices and Authority to Print. 2) She diligently searched for the documents in April 2013 but was unable to locate or recover them. 3) The documents were never confiscated by law enforcement and she executed the affidavit to establish the facts and request replacements from the appropriate government agencies.

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707 views1 page

Affidavit of Loss - Printer's Certificate of - Dungca, Rebecca

Rebecca Dungca executed an affidavit of loss stating that: 1) She is the owner of BI-SY EAT RESTAURANT and has lost her Printer's Certificate of Delivery of Receipts/Invoices and Authority to Print. 2) She diligently searched for the documents in April 2013 but was unable to locate or recover them. 3) The documents were never confiscated by law enforcement and she executed the affidavit to establish the facts and request replacements from the appropriate government agencies.

Uploaded by

Karlayaan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOC, PDF, TXT or read online on Scribd
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REPUBLIC OF THE PHILIPPINES )

_________________________ City, )

AFFIDAVIT OF LOSS

I, DUNGCA, REBECCA y DELA CRUZ Filipino, of legal age, single and with
business address at 64 D. Mangubat St.,Zone 3, Dasmarinas, Cavite, after having duly
sworn according to law , depose and state THAT :

1. I am the owner of BI-SY EAT RESTAURANT with the same business address
stated above and TIN No. of 217-840-804-001 ;

2. I have a Printer’s Certificate of Deliver of Receipts/Invoices from El Marysh


Printing & General Merchandise SN 0001 to 1250 on June 07, 2004 with
Printer’s Accreditation No. OCN 1AU00000240689 together with Authority To
Print and attached Tax Payer-user’s Sworn Statement ;

3. Sometimes in April 2013 when I tried to retrieve the original copies of the
above mentioned certificate together with authority to print and attached Tax
Payer-user’s Sworn Statement for proper filing with other BIR records and
safekeeping purposes, the same could no longer be located ;

4. Despite of diligent efforts exerted, I could no longer locate, find or recover the
said Authority To Print , Printer’s Certificate of Deliver together with attached
Tax Payer-user’s Sworn Statement , and to the best of my knowledge, the same
are truly lost ;

5. The said Authority To Print, Printer’s Certificate of Deliver of Receipts/Invoices


together with Tax Payer-user’s Sworn Statement are never 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;

6. This affidavit is being executed in order to establish all the facts herein above
narrated for the information and guidance of the authority concerned ; to attest to
the truth and veracity of the foregoing, to request for a replacement of the said
from respective government agencies as may be applicable and for whatever legal
purpose the same it may serve .

IN WITNESS WHEREOF, I have hereunto affixed my signatures this 27 th day of


April 2015 in Dasmarinas City.

REBECCA DELA CRUZ DUNGCA

Affiant
TIN 217 -840-804-001

SUBSCRIBED AND SWORN to before me this 27 th day of April 2015 in


Dasmarinas City exhibited to me his valid TIN / Voter’s ID ( see attached xerox copy)

NOTARY PUBLIC
Doc. No. ________
Page No ________
Book No. ________
Series of 2015 _____

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