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Republic of the Philippines)

Province of Cagayan )
Tuguegarao City ) S.S


I, NENITA USAL, Filipino, of legal age, married, and a resident of #9

Maguigad Street, Atulayan Sur, Tuguegarao City, Cagayan, after being sworn
to in accordance with law, depose and state THAT:

1. I am a holder of a Philippine passport;

2. Together with other pertinent documents, I placed my passport in a

plastic envelope;

3. On September 14, 2018 during the onslaughtof Typhoon Ompong,

we evacuated from our house and fled for our safety from the
incoming flood;

4. After the typhoon, we went back to our house and noticed that
some of our things were ruined and missing including the plastic
envelope were I kept the said passport;

5. The aforementioned situation was a fortuitous event beyond my

control after exercising extraordinary care and diligence;

6. I exerted allefforts to locate and recover the said passport, and the
same is now considered lost for all legal purposes;

7. Considering the foregoing circumstances, it is requested that a new

passport be issued to the undersigned, in lieu of the lost passport,
subject to compliance with the prescribed requirements; and

8. Finally, I am executing this affidavit to attest to the truth of the

foregoing facts and for all legal intents and purpose that it may


IN WITNESS WHEREOF, I hereto set my hand this 6th of November at

Tuguegarao City, Cagayan, Philippines.


SUBSCRIBED AND SWORN to before me this 7th of November at
Tuguegarao City, Cagayan, Philippines, affiant exhibiting to me his
Identification Card, the number written below his name, as proof of his

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2018.