REPUBLIC OF THE PHILIPPINES)

Province of Surigao del Norte ) S.S.

City of Surigao )
x-----------------------x

AFFIDAVIT OF LOSS

I, MAREFIL ILIGAN MANLIMOS, of legal age, Filipino, single, and a resident of

Bay-ang, Socorro, Surigao del Norte, Philippines, after having been duly sworn in accordance
with law, hereby depose and state:

1 That I was issued a Philippine Passport by the Department of Foreign Affairs in

Manila City;
2 That recently I had tried to look for the said passport but the same could not be
found;
3 That despite diligent search and efforts to locate the said passport, I could not find
the same such that I now believe that it is now lost beyond recovery;
4 As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing
and to support the application for the issuance of new one in lieu of the one which
was lost.

IN WITNESS WHEREOF, I have hereunto set my hand this 6 th day of January 2011 at
Surigao City, Philippines.

MAREFIL ILIGAN MANLIMOS

SUBSCRIBED AND SWORN to before me, this 6th day of January 2011, by the Affiant
whom I have identified through competent evidence of identity and who exhibited her Bureau of
Internal Revenue Tax Identification Number 208-053-688-000.