REPUBLIC OF THE PHILIPPINES )

SAN NICOLAS, ILOCOS NORTE )S.S

AFFIDAVIT OF LOSS
I, JANISA MACASIRAY VILLANUEVA, of legal age, married, Filipino
citizen and a resident of Brgy. Mallalatang Tunggui, Reina Mercedes, Isabela
Philippines, under oath, do hereby state and depose that:
1. I am a holder of a Philippine Passport Bearing No. EB7361115 issued to
me by Department of Foreign Affairs of the Philippines (DFA) Pampanga;

2. Back then, I remember putting said passport in one of the cabinets at our
house for safekeeping and only brings the same out when needed;

3. Last Year, said passport was no longer in the said cabinet where I usually
and last kept it, reason to me still unknown;

4. I immediately exerted diligent search and inquiry in finding said passport,

but my efforts proved futile. Hence, I now deem it lost and beyond
recovery;

5. Said passport was neither seized nor confiscated by competent authorities

for any violation of law, rules, or ordinances;

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

statements as well as to request the DFA-San Nicolas to issue me a new
passport in lieu of the expired and lost one; and

7. Finally, I am executing this affidavit for all intents and purposes this may
serve.
IN WITNESS WHEREOF, I set my hand this 19th day of February 2020 in
San Nicolas, Ilocos Norte, Philippines.

JANISA MACASIRAY VILLANUEVA

Affiant
VIN NO. 3125-0035A-F0689JMV20000-4

SUBSCRIBED AND SWORN TO before me on the date and place

written above.

Doc. No. 505;

Page No. 102;
Book No. CLXXVII;
Series of 2020.