REPUBLIC OF THE PHILIPPINES )

City of Roxas ) S.S.

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AFFIDAVIT
I, JOVEN F. CANOBIDA, Filipino, of legal age, married and a resident
of Brgy. Bito-on Ilaya, Cuartero, 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 said Philippine passport were placed and kept inside

the house of my father-in-law where my family and I were
staying;

3. That on January 1, 2020 at around 12:30 in the morning

while we were sleeping inside the house of my father-in-
law, we were awakened by my niece informing us that the
house was on fire. As we woke up, the house was covered
by smoke. Fire had immediately spread all over the house.
The house was totally burned. We immediately went
outside. A Police Blotter Excerpt with Blotter Entry No.
2020-01-33 stating these facts is hereto attached;

4. That on said incident, my family’s safety including my wife

and two minor children was my top priority. Everything
was succumbed by fire including my Philippine
passport;

5. We were left by nothing except ourselves and some

personal important belongings;

6. That I am executing this affidavit to attest to the truth of

the foregoing facts and to request for a replacement of said
cards.

IN WITNESS WHEREOF, I have hereunto set my hand this 7 th

day of January, 2020 at the Roxas City, Philippines.

JOVEN F. CANOBIDA
Affiant

SUBSCRIBED AND SWORN to before me this 7th day of

January, 2020 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.