Affidavit of Loss COR

REPUBLIC OF THE PHILIPPINES PROVINCE OF NORTHERN SAMAR MUNICIPALITY OF CATARMAN)

) )S.S.

AFFIDAVIT OF LOSS I, MARISSA ESPINA-ENCENARES, of legal age, Filipino, married and residing at Rizal Street, Kinabranan I, Allen, Northern Samar, Philippines, after being sworn in accordance with law, depose and say: 1 That I am the registered owner of RIZMHUND FOOTWEARS, with office address at Rizal St., Kinabranan Zone I, Allen, Northern Samar; 2 That a Certificate of Business Name Registration was issued to me by the Department of Trade and Industry which unfortunately lost during typhoon Seniang when we evacuate our office, and diligent efforts in search of the same proved futile; 3 That I am executing this affidavit to attest to the truth of the foregoing circumstances and for the purpose of informing the proper authorities as well as for other legal purpose it may best serve and protect my interest; 4 Affiant sayeth naught. IN WITNESS WHEREOF, I have hereunto set my hand this __________, in the Municipality of Catarman, Province of Northern Samar, Philippines. MARISSA ESPINA-ENCENARES Affiant SUBSCRIBED AND SWORN to before me this ___________, in Catarman, Northern Samar, Philippines, by affiant who is known to me to be the same person who executed and personally signed the foregoing instrument before me and avowed under penalty of law to the whole truth of the contents of said instrument. Doc. No._____; Page No._____; Book No._____; Series of 2015.