Republic of the Philippines )

City of Baguio ) S.S.

AFFIDAVIT OF LOSS
OF PASSPORT

I, _________________________, of legal age, Filipino, single, and a resident of

____________________________, Baguio City, after having been duly sworn to in
accordance with law, hereby depose and state THAT:

1) I was issued a Philippine Passport by the Department of Foreign

Affairs (DFA); however, I can no longer recall the Passport Number
of the said Passport and the date of its issuance;

2) On or about September 2014 I noted that the said passport was

missing;

3) To my knowledge my passport was lost while I was traveling from

Caloocan City to Baguio City, while said passport was in my
backpack that was mixed with other bags and other personal effects
of our companions during that trip;

4) I took great pains to look for the said passport but to no avail;

5) Despite diligent search and efforts to locate the said passport, I

could not find the same such that I now believe that it is now lost
beyond recovery;

6) 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 11th day of

October, 2019 at Baguio City, Philippines.

________________________
Affiant
ID_____________________
Issued in ___________________
On ___________________

SUBSCRIBED AND SWORN TO before me this 11th day of October, 2019

at Baguio City, Philippines, affiant exhibiting to me her valid proof of
identification.

Doc. No. 52;

Page No. 11; Notary Public
Book No. I;
Series of 2019.