REPUBLIC OF THE PHILIPPINES )

PROVINCE OF ISABELA )
MUNICIPALITY OF ILAGAN )S.S.

AFFIDAVIT OF LOSS

I, CRISONIA SORIANO TAYLAN, Filipino, of legal age, single and

residing at Sto. Niño, Tumauini, Isabela, after having been duly sworn to in
accordance with law do hereby depose and say:

1. That I am a holder of Philippine Passport with passport no. UU0456761

duly issued by the Department of Foreign Affairs-Tuguegarao, Cagayan
on 26 January 2007;

2. That sometime in November 2011 the said passport got lost;

3. That said passport has not been confiscated by the Department of Foreign
Affairs or any government agency for any violation of law or rules and
regulations;

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

5. That I execute the foregoing affidavit in order to attest to the truth of all
the foregoing facts and in order to show that my passport got lost and
could not be found despite diligent efforts and in order to secure a new
passport in lieu of the lost one.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 12th

day of March 2012 at Calamagui 2nd, Ilagan, Isabela.

CRISONIA SORIANO TAYLAN

Affiant
SSS NO. 01-0952933-0

SUBSCRIBED AND SWORN to before me this 12th day of March 2012,

affiant exhibiting to me her competent evidence of identity above-stated.

Doc. No. ;
Page No. : Notary Public
Book No. II;
Series of 2012