AFFIDAVIT OF LOSS

I, JOHNNY SENGSON ESCALONA, of legal age, Filipino, married and a

resident of 32 Nicanor Roxas St. Sta. Mesa Heights, Quezon City, after
having been duly sworn to in accordance with law, depose and state THAT:

1. On April 10, 2013, I was issued a Philippine Passport by the Department
of Foreign Affairs in Manila bearing Passport No. EB 7833152;

2. Recently, I had tried to look for the said passport but the same could not be
found;

3. Despite diligent search and efforts to locate the said passport, I could not
find the same such that I believe that it is now lost beyond recovery;

4. As such, I am executing this affidavit to attest to the foregoing facts and to
support the application for the issuance of a new one in lieu of the one which
was lost.

IN WITNESS WHEREOF, I have hereunto set my hand this 12
th
of
August 2014 in Quezon City, Metro Manila, Philippines.





____________________
Affiant
Drivers License No.
_____________

SUBCRIBED AND SWORN TO before me this ______________ in
_________________, Philippines, affiant exhibiting to me his valid proof
of identification.

Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2014.