Republic of the Philippines )

Province of Zamboanga del Norte )S.S.

Municipality of Sindangan )
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AFFIDAVIT OF MUTILATION

I, LESTIE ANGELES SELDA, of legal age, single, Filipino, with

residence and postal address at Tinuyop, Leon B. Postigo, Zamboanga del Norte,
after having been duly sworn to an oath in accordance with law, do hereby depose
and say: THAT-
1. I am an applicant of the renewal of my passport in the Department of
Foreign Affairs;
2. In the process of my renewal of my passport in the DFA, I was required
to submit a copy of the old passport;
3. I am a holder of Philippine Passport No. MM289681issued on January 6,
2004 by the Department of Foreign Affairs in Zamboanga City. However
this passport is unfortunately now mutilated or defaced;
4. Since I am applying for renewal of my mutilated passport, I am reporting
the mutilation of my Philippine Passport to the DFA;
5. My passport is now mutilated because it was drenched in rain when I was
carrying the said passport sometime in the year 2009. Because I did not
notice that it was drenched in the rain, my passport was then mutilated or
defaced because of the deterioration of the paper due to the drenching in
the rain;
6. I execute this affidavit for the purpose of giving true and correct
statement surrounding the mutilation of my passport.

Affiant further sayeth naught.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

_______ day of November, 2019 in Sindangan, Zamboanga del Norte.

LESTIE ANGELES SELDA

Affiant
Voter’s Identification No. 7226-0034B-J2066LAS20001-5
Issued by COMELEC LEON B. POSTIGO

SUBSCRIBED AND SWORN TO before me this ______________ in

Sindangan, Zamboanga del Norte, Philippines, affiant exhibiting her Voter’s
Identification ID with Number as stated herein.