Republic of the Philippines }

Province of La Union } s.s

Municipality of Naguilian }

AFFIDAVIT OF LOSS

I, DEBBIE RONA CORPUZ PEREZ, of legal age, single, Filipino citizen,

a lawyer, and a resident of #22 Naguilian Road, Ortiz, Naguilian, La Union,
Philippines, after having been sworn to an oath in accordance with law, do
hereby depose and state that:

1. I am a holder of a Philippine passport with Passport No. EB1353026

issued by DFA La Union on November 12, 2010 and which expired
on November 11, 2015;

2. Sometime in May, 2015, I used the aforesaid passport as one of the

government-issued ID in my request as authorized representative
for the bank details of my father;

3. The following day, when I needed to present an ID, I noticed that my

passport was not in my bag;

4. That I went back in the bank where I last used the said passport but
was told that the passport was not there;

5. I exerted all efforts to find and search the said passport but to no
avail, my efforts are futile;

6. I executed this affidavit to attest to the truth of the foregoing and for
all intents and purposes.

IN WITNESS WHEREOF, I have hereunto set my hand this 21st day of

May, 2018 at Naguilian, La Union.

DEBBIE RONA CORPUZ PEREZ

Affiant
 SUBSCRIBED AND SWORN TO BEFORE ME this 21st day of May,
2018 at Naguilian, La Union, Philippines by affiant who is personally known
to me and upon showing to me her IBP ID issued by the Integrated Bar of the
Philippines as proof of her identity.

Doc. No. ____

Page No.____

Book No.____

Series of 2018