Affidavit of Loss - Receipts

REPUBLIC OF THE PHILIPPINES ) Province of Negros Oriental ) City of D!agete )S"S" # $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $# AFFIDAVIT OF LOSS CABALLERO% Fili&ino% I% JOSIE CABALLERO Fili&ino% of legal age% single% single% an' a resi'ent resi'ent of (alencia%  Negros Oriental% Pili&&ines% after *eing 'ly ' ly s+orn in accor'ance +it la+% 'e&ose an' state,

-" Tat Tat I a! te sole sole &ro&ri &ro&rieto etorr of Unicor Unicorn n Diving Diving Servic Services% es% Hostel Hostel an' Resta Restaran rantt locate' at Po*lacion% Dain% Negros Oriental. /" Tat te sai' *siness a' *een 'ly registere' +it te Brea of Internal Revene last 0ly -1% /2-3. 4" Tat s*se5ently% te sai' *siness ave &rinte' -/ *oo6lets of recei&ts n!*ere' fro! 222-$2322. 7" Tat so!eti!e aron' te early 5arter of /2-8% I 'iscovere' tat !y recei&ts +it  *oo6lets n!*er 8$-- +ere !issing. !issing. 9" Tat 'es&ite 'iligent searc an' efforts to locate te a*ove !entione' recei&ts% I col' not fin' te sa!e sc tat I no+ *elieve tat tey are no+ lost *eyon' recovery. 3" :s sc% I a! e#ecting tis :ffi'avit of Loss to attest to te trt of te foregoing facts an' for te closre of !y *siness *efore te BIR" IN ;ITNESS ;HEREOF ;HEREOF%% I ave erento set !y an' tis