Republic of the Philippines )

Metro Manila ) S.S.

AFFIDAVIT OF LOSS
OF PASSPORT

I, JOSEPH VIR DANIEL MEMPIN FERRER, of legal age, Filipino,

married, and a resident of #37 Sampaguita St., Arevalo, Iloilo, after having been
duly sworn to in accordance with law, hereby depose and state THAT:

1) On 12 September 2018, I was issued a Philippine Passport by the

Department of Foreign Affairs with Passport Number P8715301A;

2) Sometime around January 2023, I noted that the said passport was
missing;

3) To my knowledge my passport was lost when I went back from

Amaia, Cubao to 14 Mahusay St. U.P. Village;

4) I took great pains to look for the said passport but to no avail;

5) Despite diligent search and efforts to locate the said passport, I

could not find the same such that I now believe that it is now lost
beyond recovery;

6) I am executing this Affidavit of Loss to attest to the truth of the

foregoing and to support the application for the issuance of new
one in lieu if the one which was lost.

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

January, 2023 at Manila, Philippines.

JOSEPH VIR DANIEL MEMPIN FERRER

Affiant

SUBSCRIBED AND SWORN TO before me this ____ of January, 2023 in

Manila, Philippines, affiant exhibiting to me his valid proof of identification with
TIN 324-634-713-000

Doc. No. __________;

Page No.__________;
Book No.__________;
Series of 2023.