Republic of the Philippines )

City of Cabanatuan )
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AFFIDAVIT OF LOSS

I, LIERIZA JOY L. PAGADUAN, of legal age, a resident of Zone

#6 San Josef Sur, Cabanatuan City, Nueva Ecija, after having duly sworn to
in accordance with law, do hereby depose and state:

1. That, I am the owner of a Philippine passport;

2. That, I kept this passport inside an envelope which I usually leave

in our home;

3. That, a strong typhoon ravaged the province sometime in

November 2020 which caused the valuables and implements in our home to
be swept away by the flood;

4. That, after the inundation, I tried to look for the envelope

containing my passport but the same can no longer be found and I suspect
that said envelope was one of the things that was swept away by the flood;

5. That, I exerted diligent efforts to look after my passport but the

same proved futile;

6. I executed this affidavit to attest to the truthfulness of the foregoing

facts

IN WITNESS WHEREOF, I hereunto set my hand this 13th of

August 2021 at Cabanatuan City.

LIERIZA JOY L. PAGADUAN

Affiant

SUBSCRIBED AND SWORN to before me this 13th day of August

2021 at Cabanatuan City.

Atty. Glino Barsen G. Claudio

Administering Officer
Pursuant to RA 9406