Republic of the Philippines ]

Province of Bohol ]
Municipality of Carmen ] S.S.

AFFIDAVIT OF LOSS
(Re: Passport)

I, CORAZON D. AMBA, Filipino, of legal age, married and a resident of Purok Matin-
ao 1, Campagao, Bilar, Carmen, Bohol, Philippines, after being duly sworn in accordance with
law, hereby depose and say:

1. That I am a holder of a Passport with Passport No. P2373725B duly issued under
my name by the Department of Foreign Affairs (DFA) Manila;

2. That said Passport with Passport No. P2373725B lost last 2021;

3. That I exerted diligent efforts to find and recover the aforesaid Passport with
Passport No. P2373725B, however, my efforts proved futile as until now, its
whereabouts still could not be ascertained, hence, I considered it to be lost for all
intents and purposes;

4. That the said Passport with Passport No. P2373725B was not transferred to any
person for consideration or used as collateral to secure obligations;

5. That I execute this affidavit voluntarily to attest to the truth of the foregoing
statements to support my request for the issuance of another Passport with Passport
No. P2373725B in lieu of the lost one;

6. That further, I execute this affidavit for whatever legal purpose this may serve.

IN WITNESS WHEREOF, I hereunto set my hand this 27 th day of March, 2023 at

Carmen, Bohol, Philippines.

CORAZON D. AMBA
Affiant
VIN: 12080009BC2286CDA20000-2
Issued by the COMMISSION ON ELECTIONS (COMELEC)
Bilar, Bohol

SUBSCRIBED AND SWORN TO before me this 27th day of March, 2023 at Carmen,
Bohol, Philippines.