REPUBLIC OF THE P HILIPPINES)

Province of Palawan) S.S.

City of Puerto Princesa)
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AFFIDAVIT OF LOSS

I, MARGARETTE COLLIN ROTONE RECTO, Filipino, of legal age, single and a

resident of Barangay Corong Corong, El Nido, Palawan, after being duly sworn in
accordance with law, depose and state:

1. That I am a bona fide holder of a Passport Identification Card issued by

Department of Foreign Affairs Pampanga with registration number EC1756745;

2. That sometime in June 8, 2019, when I was on my way home, I

inadvertently lost the envelope where the said Passport was placed;

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

4. That the aforementioned Passport was NOT valid at the time of its loss;
and

5. As such, I am executing this Affidavit of Loss to support the issuance of a

new Passport in lieu of what was lost and to attest to the truth of the foregoing and for
whatever legal purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ____________________

in the City of Puerto Princesa, Palawan.

MARGARETTE COLLIN ROTONE RECTO

Driver’s License No.: C10-14-019414
Valid Until: 2022-07-29
Affiant

SUBSCRIBED AND SWORN to before me, this this ___________________ in the City
of Puerto Princesa, by the Affiant whom I have identified through competent proof of
identity indicated under her name.

Doc. No. ______;

Page No. ______;
Book No.______;
Series of 2019.