Professional Documents
Culture Documents
1. That the undersigned was issued a Philippine Passport by the Department of Foreign
Affairs (DFA) in Manila/Consular Office/ Philippine Embassy/Consulate with the
following details: Philippine Passport No: _____________________, Date of Issue:
___________________, and Issuing Authority: ______________________.
2. That the said passport was lost on ______________________ (Date) under the
following circumstances:
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3. That the undersigned exerted all efforts possible to locate the said passport but to no
avail;
4. That the undersigned fully understands that the said passport is automatically deemed
cancelled upon declaration of loss and that if found, it can no longer be used;
5. That the undersigned is executing this Affidavit of Loss in connection with his/her
present application for a new Philippine passport; and
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ADMINISTERING OFFICER / NOTARY PUBLIC