AFFIDAVIT OF LOSS OF PHILIPPINE PASSPORT

I, _______________________________________________________________________, a Philippine citizen, of legal age,

single / married, after having been sworn to in accordance with law, do hereby depose and say, that:
1. The following are my complete contact details:
Address in France or Monaco

Telephone Number(s)

2. The following are my TRUE AND REAL birth and personal data:
Last Name
First Name
Middle Name
Date of Birth
Place of Birth
3. I am the holder of a Philippine passport with the following data:
Passport Number
Date of Issue
Date of Expiry
Place of Issue

4. The following are the information about my trip to France:

Place of Origin

Date of Departure from Place of Origin

Name of Airline

Destination

Places of Transit

Date of Arrival in France

Place of Entry in France

Name of Travelling Companion

Relationship to Travelling Companion

5. The aforementioned Philippine passport was lost on ________________________________ at approximately ______

am/pm, due to the following circumstances: (please narrate the circumstances leading to the loss of your passport)
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
___________________________________________________________________________________________________;
6. Said passport was lost due to the foregoing circumstances and not through negligence, with willful intent or for any ulterior
motive on my part;
7. Ernest efforts have been exerted to recover my passport, but to no avail; and
8. I am executing this Affidavit in support of my application for a new Philippine passport and for whatever legal purpose and
intent it may serve.
IN WITNESS WHEREOF, I hereby sign this Affidavit on ____________________________ in ________________________.
___________________________________________
Printed Name and Signature
EMBASSY OF THE PHILIPPINES
CONSULAR SECTION
PARIS, FRANCE

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) SS
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SUBSCRIBED AND SWORN TO before me on _________________________________at the Embassy of the Philippines, Paris, France.

Doc: PA-_______; Book ______; Page ______; Series of ______; OR No. ______ Service No. _______; Fee Paid ______