REPUBLIC OF THE PHILIPPINES)

BACOLOD, LANAO DEL NORTE) S.S.

AFFIDAVIT OF LOSS

I, AIDA CABILI, of legal age, married, Filipino citizen and residing at

Liangan West, Maigo, Lanao del Norte after having been sworn in accordance
with law hereby depose and state:

1. I am the proprietor of AIDA STORE, registered under existing laws and

occupant of Stalls No. 13 of the Municipal Public Market with principal
address at Purok 3, Poblacion, Bacolod, Lanao del Norte;
2. That sometime on February 9, 2018 at around 10:40 o'clock in the
evening, a big fire broke out in the Municipal Public Market which
caused the market, including our stall completely destroyed, damaged
and spoiled all of the assorted stocks and merchandise stored in the said
area worth Five Hundred Fifty Five (555,000) thousand pesos;
3. Further as a result of the incident, all my important documents like my
Bureau of Internal Revenue papers, Certificate of Registration, Business
Receipt, Business Permits and Records, Valid Identification cards and
other documents were lost and destroyed;
4. That I am executing this affidavit to attest to the truth and veracity of the
foregoing facts of my own personal knowledge and belief and for what
ever legal purpose this affidavit may serve.

AFFIANT FURTHER SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto set my hand this 3rd day

August 2018 at Bacolod, Lanao del Norte.

AIDA CABILI
Affiant
Competent Proof of Identity
TIN No. 434-898-070-000

SUBSCRIBED AND SWORN TO before me, this 3rd day August

2018 at Bacolod, Lanao del Norte, with affiant having exhibited to me her
competent proof of identity.

ATTY. ALFONS JANSSEN P. MARCERA

Doc. No. : ________;
Page No. : ________;
Book No. :IV;
Series of 2018.
Notary Public
Serial No. 17-152
Iligan City- Lanao del Norte
Until December 31, 2018
IBP Lifetime No. 01840
Roll No. 70427- July 31, 2017
PTR No. 3520052-12/31/18
IBP No. 021317-01/31/18
MCLE 2016 Bar Passer