REPUBLIC OF THE PHILIPPINES )

CITY OF TUGUEGARAO ) S.S.

AFFIDAVIT OF LOSS AND EXPLANATION

I, MARYCRIS PASCUAL CABISON, of legal age, Filipino, married and a

resident of Lasam, Cagayan, after being sworn to in accordance with law, do hereby
depose and state:

1. That in the year 2013, I was issued a Philippine passport when I was still
single and which has not yet expired;

2. That sometime in the year 2015, my aforementioned passport which I placed

inside the cabinet in our house was lost and/or missing and despite diligent
search, I failed to recover the same;

3. That when I applied for passport, I used my maiden name MARYCRIS

PASCUAL. However, when I applied for the re-issuance of another passport
in lieu of the lost one, I indicated in my application form that I am a first time
applicant on account of the fact that I will be using my married name,
MARYCRIS PASCUAL CABISON in my passport;

4. That I am executing this affidavit to attest to the fact of loss of my Philippine

passport and for further purpose of securing another using my married name
in lieu of the lost one and to explain the reason that I indicated first time
applicant in my application form.

IN WITNESS WHEREOF, I have hereunto set my hand this 18 th day of August

2016 at Tuguegarao City.

MARYCRIS PASCUAL CABISON

Affiant

SUBSCRIBED AND SWORN to before me on the date and place above stated.