REPUBLIC OF THE PHILIPPINES )

Zamboanga City )S.S.

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AFFIDAVIT OF LOSS

I, ESTRELLA G. CARZA, of legal age, single, Filipino citizen and a resident of Proper Mangusu,
Zamboanga City, Philippines, after having been duly sworn to in accordance with law, hereby depose and state that:

1. I am the lawful holder of Philippine Passport issued by the Department of Foreign Affairs at Zamboanga
City;

2. Said Passport was placed in a filing cabinet at our family home where all my legal documents were also
kept. However, I recently discovered that my Philippine Passport was lost;

3. I diligently exerted efforts to locate the said Passport, but all my effort proved futile that the same is now
deemed lost and beyond recovery:

4. The said passport has not been encumbered, sold, pledged, assigned, alienated, transferred, donated, or
given as collateral for any debt or obligation to or in favor of any person or entity;

5. I understand that my declaration of the abovementioned passport as lost shall be constructed as satisfactory
proof that the passport was lost, in compliance with Section 15 of RA 8239 or the Philippine Passport
Act of 1996;

6. I further understand that said passport will be immediately deemed cancelled and may no longer be used
for travel or other purposes. As such, In case the said passport is found or retrieved, undersigned will
immediately surrender it to the Department of Foreign Affairs.

7. I am executing this affidavit to attest to the veracity of the foregoing facts and for whatever legal purpose it
may serve under the law.

IN WITNESS WHEREOF, I have hereunto set my hand on this 19 th day of March 2021 in the City of
Zamboanga, Philippines.

ESTRELLA G. CARZA
Affiant

SUBSCRIBED and SWORN to before me on this 19 th day of March 2021 at Zamboanga City, affiant
having exhibited to me her Barangay ID bearing numbers 20-2099 issued at Zamboanga City, Philippines..

MARIA FE C. GAUGANO
Notary Public – Zamboanga City
Notarial Commission No. 2021-002
Until December 31, 2022
G/F, LDM Bldg., Pilar St., Zamboanga City
PTR No. 2161536 - 12/22/2020 – Z.C.
IBP No. 133938 - 12/04/2020 – Z.C.
Roll No. 53057 – 4/26/2007

Doc. No. ______

Page No. ______
Book No. _____
Series of 2021