Republic of the Philippines )

Camiling, Tarlac ) S.S.

AFFIDAVIT OF MUTILATION
OF PHILIPPINE PASSPORT

I, MONINA LAMORENA ANDRES, 53 years old, married, Filipino

citizen, and a resident of Barangay Cacamilingan Sur, Camiling, Tarlac,
Philippines, under oath, do hereby depose and state THAT:

1. I am a holder of a Philippine Passport with Number XX5094732 issued

by the Department of Foreign Affairs Consular Office, Pampanga on
December 3, 2009;

2. Said passport was kept in a bag together with my other personal

documents;

3. Sometime in June 2016, I took the said bag and washed it without
realizing that my passport was left in one of its pocket;

4. I tried to let my passport dry but most of the entries therein are no
longer legible. Hence, the said passport could now be considered as
beyond recovery as it could no longer serve its purpose;

5. I am executing this Affidavit to inform the Department of Foreign

Affairs, Philippines regarding the mutilation of my passport and to
request for a new passport in lieu of the mutilated one;

6. Finally, I am executing this Affidavit to attest to the truth of the

foregoing statements and for all legal intents and purposes it may
serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 27th day of

January, 2017 at Camiling, Tarlac, Philippines.

MONINA L. ANDRES
Affiant

SUBSCRIBED AND SWORN to before me on the date and place

indicated above. Affiant exhibited before me her Unified Multi-Purpose ID with
CRN-006-0080-0933-7 issued by the GSIS, Philippines.

Doc. No. ______

Page No. ______
Book No. ______
Series of 2017
 Republic of the Philippines )
City of Tarlac ) S.S.
x--------------------------x

AFFIDAVIT OF DESTRUCTION/MUTILATION

            I, ROMMEL DOMINGO FACUN, of legal age, married, Filipino citizen,

and presently residing at Mabini, Gerona, Tarlac, after having been duly sworn
to in accordance with law, do hereby depose and say:

1.  That I am a holder of Philippine Passport No. EC2423282 issued on October

15, 2014 by the Department of Foreign Affairs in Manila;

2.  That the said passport was damaged/mutilated because my six (6) year old
daughter found my passport and thereafter wrote and tore its page.

3. That the damage on the said passport has rendered it unusable for travel
purposes and therefore I request the Department of Foreign Affairs to issue a
replacement passport in my favor; and,

4.  That I attest to the veracity of the foregoing information.

IN WITNESS WHEREOF, I have hereunto set my hand this 21 st day of

June 2017 at Tarlac City, Tarlac, Philippines.

ROMMEL DOMINGO FACUN

Affiant
                                

            SUBSCRIBED AND SWORN to before me this 21st day of June 2017

in Tarlac City, Tarlac, Philippines, affiant exhibiting to me his competent evidence
of identity by way of UMID with No. 0111-2184239-5 issued by the Social
Security System (SSS).