REPUBLIC OF THE PHILIPPINES )

City of Roxas ) S.S.

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AFFIDAVIT

I, JOSELITO M. MISAL, Filipino, of legal age, married and a

resident of Brgy. Liong, Roxas, Capiz, after having been duly
sworn in accordance with law, hereby depose and state:

1. That I am a Philippine citizen and holder of Philippine

passport;

2. That on April 5, 2015 at 9:00 am while I was travelling

going home, I discovered that my brown envelop which was
in my custody the moment I went out from house was
missing. Inside the said envelop contained some of my
important documents, among which was my passport. A
Police Blotter Report stating the circumstances of how I lost
my passport is hereto attached;

3. That efforts were exerted to locate the lost passport, but

in spite of diligent search, it could not be found and the
same is now beyond recovery;

4. That I need my passport urgently because I am planning

to work abroad;

5. That in view of the foregoing explanation, it is requested

that a new passport be issued to the undersigned, in lieu of
the lost passport, subject to compliance with prescribed
requirements;

6. That I attest to the veracity of the above affirmation.

IN WITNESS WHEREOF, I have hereunto set my hand this

26th day of November, 2019 at the Roxas City, Philippines.

JOSELITO M. MISAL
SSS I. D No. 33-9431349-7

SUBSCRIBED AND SWORN to before me this 26th day of

November 2019, in the City of Roxas, Philippines. I further
CERTIFY that I have personally examined the affiant, and I am
fully satisfied that he voluntarily executed the foregoing Affidavit,
and he read and understood the contents thereof.