REPUBLIC OF THE PHILIPPINES )

VALENZUELA CITY ) S.S.

AFFIDAVIT OF LOSS

I, MARNIE MALIPOT FUNTANILLA, of legal age, Filipino citizen and

with address at Bigbiga, Santiago, Ilocos Sur, after having been duly sworn to in
accordance with law do hereby depose and say:

1. That some time on June 27, 2019, when I moved home with my sister, I
discovered that my passport was missing;

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

3. That I am executing this affidavit to attest to the foregoing facts and to

support the application for the issuance of a new one in lieu of the one which
was lost.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

_______________ day of ____________, 2019 here at City of Valenzuela.

MARNIE M. FUNTANILLA
Affiant

SUBSCRIBED AND SWORN to before me this ________ day of

____________ 2019 in Valenzuela. Affiant exhibited to me her Birth
Certificate

NOTARY

Doc No.
Page No.
Book No.
Series of 2019