Affidavit of Loss Original Copy of BFAD License

(Affidavit of Loss Original Copy of BFAD License)

Republic of the Philippines)
Province of____________________) S.S.
City/Municipality of_____________)
x – – – – – – – – – – – – – – x

AFFIDAVIT OF LOSS

I,_____________, Filipino, of legal age,(single/married / widow), and a resident of_____________, Philippines, after being duly sworn in accordance with law, depose and state:

That I am the owner of_____________, a company engaged primarily in food processing / manufacturing particularly of_____________and is duly registered with the Bureau of Food and Drugs (BFAD).

That being registered with BFAD, I was issued a BFAD License to Operate LTO No.____________on_____________which is valid until_____________

That on____________, because we were to add additional products, I have surrendered the original copy of the above-mentioned BFAD License to Operate with the BFAD office in City of Manila, which copy was duly received by BFAD as shown by the acknowledgment and signature of_____________of BFAD in the photocopy of the said license.

However, upon verification and inquiry with the said office of the BFAD, the original copy of the said license could not be found and that despite of diligent search and efforts, the same could no longer be found such that I now believe that it is now lost beyond recovery.

As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing and for whatever legal purposes that this may serve

IN WITNESS WHEREOF,I have hereunto set my hand this____________at____________, Philippines.

Affiant

(JURAT)