Republic of the Philippines )

City of Tacloban )S.S.

AFFIDAVIT OF LOSS

I, LYRA JANE M. HAPLASCA, of legal age, Filipino, single, and with

residence at Brgy. 60 Aslum, Sagkahan, Tacloban City, after being duly
sworn to in accordance with law, hereby depose and state:

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

Affairs RVIII in Tacloban City;

2. That three months ago, said passport was misplaced and got lost;

3. That despite diligent search and effort to locate the said passport, I
could not find the same such that I now 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 for whatever purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 17th day of

October 2019 at Tacloban City, Philippines.

LYRA JANE M. HAPLASCA

Affiant

SUBSCRIBED AND SWORN to before me this 17th day of October

2019 in Tacloban City, affiant personally known to me.

WITNESS MY HAND AND SEAL.

Doc. No. _____;

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