REPUBLIC OF THE PHILIPPINES )

CITY OF LAOAG ) S.S.

AFFIDAVIT OF MUTILATION OF PHILIPPINE PASSPORT

I, JULIUS ERWIN LAFORTEZA CARDENAS, of legal age, Filipino citizen,

widow, and a resident Barrio Gabut Norte (20), Batac City, Ilocos Norte, under oath, do
hereby depose and state that:

I am the holder of Philippine Passport No. EC5882945 issued on 04 November 2015

by the Department of Foreign Affairs in the City of Manila;

The said passport was damaged/mutilated by reason that the same was eaten by
rats that went through the cabinet where I hid my passport;

The damage on the said passport has rendered it unusable for travel purposes and
therefore I request the Department of Foreign Affairs to renew and issue a replacement
passport in my favor;

I am executing this affidavit to attest to the veracity of the foregoing facts, and for
all legal purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 28 February 2019 at

Laoag City, Philippines.

JULIUS ERWIN LAFORTEZA CARDENAS

Affiant

SUBSCRIBED AND SWORN to before me this 28 February 2019 at Laoag City,

Philippines, with the affiant exhibiting to me his identification card, to wit, LTO
Professional Driver’s License No. A03-08-000863 and signed said document in my
presence and sworn to that she understood the contents thereof and that the same is her
free and voluntary act and deed.

Doc. No. 89;

Page No. 19;
Book No. III;
Series of 2019.