Republic of the Philippines)

Quezon City ) S.S.

AFFIDAVIT OF LOSS

I, Joan Larrie T. Reyes, of legal age, Filipino, single and a resident of 6 Saint
Martin Street, Jonaville Subdivision, Barangay Nagkaisang – Nayon, Novaliches,
Quezon City, Philippines, after having been duly sworn in accordance with law,
hereby depose and state:

1. That on the year 2009, I was issued a Philippine Passport by the Department
of Foreign Affairs in the city of Manila;

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

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

4. As such, I am executing this Affidavit of Loss to attest to the truth of the

foregoing and to support the application for the issuance of new one in lieu
of the one, which was lost.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________ at

_______________________, Philippines.

AFFIANT
SUBSCRIBED AND SWORN to before me this _________ day of ______________ in
________________________, Philippines. The Affiant having exhibited to me
his/her Identification card no. _________________________ issued on
_________________________ at _______________________________.

NOTARY PUBLIC

Doc. No. _______

Page No. _______
Book No. _______
Series of 2018.