AFFIDAVIT OF DAMAGED PASSPORT

I, ANALYN V. LUNA, of legal age, Filipino citizen, married and a resident of Purok 7 Cobo,
Tabaco City after having been sworn in according to law, do hereby depose and state that:

1. I was issued a passport on May 15, 2019 by the Department of Foreign Affairs, Manila, a
Philippine passport with passport number P2154299B;
2. The said passport was damaged on or about November 2020 by Typhoon Rolly and that
said passport was damaged and even diligent effort to maintain its original form did not
make it possible;
3. The damage to the passport issued in my name was inadvertent and unintentional;
4. I am executing this affidavit to declare the factual circumstances as to how said passport
was damaged beyond further use and to support my present application for a new passport
to replace the one that was damaged; and that
5. Each and all of the facts stated here are true and correct, and made with full awareness that
I may be held liable for perjury and have the passport issued in my name cancelled if any
misrepresentations or falsehoods are found to have been made in this affidavit.

IN WITNESS WHEREOF, I hereby affix my signature to this affidavit, this ____day of

February 2021 at ___________________.

ANALYN V. LUNA
Affiant

SUBSCRIBED AND SWORN TO before me, in the ___________________this ____day of

February 2021, the affiant exhibiting to me her _________________ issued by ______________ on
______________ at ___________________.

Doc. No.: ____

Page No.:____
Book No.:_____
Series 2021