Republic 

of the Philippines  )
City of Pagadian            )  S.S.
Province of Zamboanga del Sur
x————————–x
 

AFFIDAVIT OF DAMAGED/MUTILATED PASSPORT

I, CERILIO C. DERRACO, of legal age, married, Filipino citizen, and presently

residing at Purok 7, Bogayo, kumalarang, Zamboanga del sur, after having been
duly sworn to in accordance with law, do hereby depose and say:

1.  That I am a holder of Philippine Passport bearing the number P1424624B

issued on April 10, 2019 and which expires on April 09, 2029 by the Department
of Foreign Affairs – CLarin;

2.  That the said passport was damaged/mutilated due to the fact that I put
the said passport at the back pocket of my pants and without my knowledge my
wife accidentally wash it, that caused the damage; 

3. That the damage/mutilation on the said passport has rendered that all

pages of the passport has a water mark and therefore I request the Department
of Foreign Affairs (DFA) that I will be able to renew my 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 6th day of February
2023 at Pagadian City, Zamboanga del Sur, Philippines.
 

CERILIO C. DERRACO
Affiant

SUBSCRIBED AND SWORN to before me this 6th day of February 2023 in

Pagadian City, Zamboanga del Sur, Philippines, affiant exhibiting to me his
competent evidence of identity by way of Driver License with Number J10-20-
000775, issued on 03/09/2020 at LTO.
 
Doc No. :  _____
Page No.: ______
Book No.: ______
Series of 2023