Republic of the Philippines )

Kidapawan City ) SS.

x--------------------------------/

AFFIDAVIT OF LOSS
I, _________________, of legal age, married, Filipino, and a resident of __________,
after having been duly sworn to in accordance with law, do hereby depose and state;

1. That sometime this June 2022, I lost my Philippine Passport issued by DFA
Davao issued on __________with expiration date __________________, and
with no. ________________;

2. That I searched all the drawers, cabinets and other places at our house to look
for it;

3. That I have exerted all means to locate said Passbook, but all my efforts
proved futile;

4. That until now the same remains at lost and nowhere to be found; and

5. That I am executing this affidavit to attest to all the above facts and to
request the authorities concerned to note the said loss.

IN TRUTH WHEREOF, I have hereunto set my hand this ____ day of August 2022 in
Kidapawan City, Philippines.

____________________
Affiant
_____________________________

SUBSCRIBED AND SWORN TO before me this ______ day of August 2022 in

Kidapawan City, Philippines.

Doc No. ________;

Page No. _______;
Book No. IV;
Series of 2022.

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