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Affidavit of Loss

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REPUBLIC OF THE PHILIPPINES )

PROVINCE OF NEGROS ORIENTAL)


CITY OF DUMAGUETE )S.S
X - - - - - - - - - - - - - - - - - - - - - - - - - - - -/

AFFIDAVIT OF LOSS
I, GINA V. NARCISO, of legal age, married, Filipino and a resident
of Poblacion, Ayungon, Negros Oriental, Philippines, after having been
duly sworn to in accordance with law, hereby depose and say:

That I am the registered owner of a Certificate of Business Name


Registration issued by the Department of Trade and Industry under the
name of GINA NARCISO STORE, located in Poblacion, Ayungon,
Negros Oriental.

That the said Business Certificate of Business Name Registration was


lost and efforts to locate the same was exhausted but to no avail.

That I am executing this affidavit to attest to the facts as herein stated.

IN WITNESS WHEREOF, I have hereunto set my hand this 4 th day


of September, 2019 in the City of Dumaguete, Philippines.

GINA V. NARCISO
Affiant

Subscibed and sworn to before me a Notary Public for and in


Dumaguete City, Province of Negros Oriental this 4th day of August,
2019, affiant exhibiting to me as competent proof of identity the current
identification document issued by an official agency and bearing her
photograph and signature, described as follows:

Name Identification Document I.D. No. Issued at

Gina V. Narciso - Voter’s Cert. No. 4602-004A-B0672GVN20000-2


WITNESS MY HAND AND SEAL.

DOMINADOR B. UY, JR.


Doc. No. ___ Notary Public until December 31, 2019
Page No. ___ for the City of Dumaguete and the Municipalities
Book No. 34 of Sibulan, Bacong, Valencia, Dauin, Zamboanguita
Series of 2019 and Siaton, all of Province of Negros Oriental
Serial No. 2018-004; IBP OR NO. 067622 – 1/9/19 – Pasig City

PTR No. 2109574 A – 1/3/19 -Dgte. City


Roll No. 35280, MCLE Compliance No. VI-0009255 – 4/14/22
REPUBLIC OF THE PHILIPPINES)
CITY OF DUMAGUETE )S.S
X - - - - - - - - - - - - - - - - - - - - - - - - - - - -/

AFFIDAVIT OF LOSS
I, FLORAVIL C. SUMBILON, of legal age, single, Filipino and a
resident of Purok Dap-Dap, Bagacay, Dumaguete City, Philippines, after
having been duly sworn to in accordance with law, hereby depose and say:

That I am the registered owner of a Certificate of Business Name


Registration issued by the Department of Trade and Industry under the
name of BING’S SPICES AND VEGETABLES Wholesale and Retail,
located in Bldg.8 Stall No. 28 Dumaguete City.

That the said Business Certificate of Business Name Registration was


lost and efforts to locate the same was exhausted but to no avail.

That I am executing this affidavit to attest to the facts as herein stated.

IN WITNESS WHEREOF, I have hereunto set my hand this 9 th day of


August, 2019 in the City of Dumaguete, Philippines.

FLORAVIL C. SUMBILON
Affiant

Subscibed and sworn to before me a Notary Public for and in


Dumaguete City, Province of Negros Oriental this 9 th day of August, 2019,
affiant exhibiting to me as competent proof of identity the current
identification document issued by an official agency and bearing her
photograph and signature, described as follows:

Name Identification Document I.D. No. Issued at

Floravil C. Sumbilon - Passport No. P4637285A

WITNESS MY HAND AND SEAL.

DOMINADOR B. UY, JR.


Doc. No. ___ Notary Public until December 31, 2019
Page No. ___ for the City of Dumaguete and the Municipalities
Book No. 34 of Sibulan, Bacong, Valencia, Dauin, Zamboanguita
Series of 2019 and Siaton, all of Province of Negros Oriental
Serial No. 2018-004; IBP OR NO. 067622 – 1/9/19 – Pasig City

PTR No. 2109574 A – 1/3/19 -Dgte. City


Roll No. 35280, MCLE Compliance No. VI-0009255 – 4/14/22

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