Republic of the Philippines )

City of Cabanatuan )
x----------------------x

AFFIDAVIT OF LOSS

I, MARGIE O. CABANSAG, of legal age, a resident of Brgy.

Lourdes, Cabanatuan City, after having duly sworn to in accordance with
law, do hereby depose and state:

1. That, I am the holder of a Philippine Passport;

2. That, said Passport was usually kept in safekeeping inside my bag;

3. That, on December 1, 2022, my child and I was in the Cabanatuan

Public Market and I brought my Passport with me to be used as proof of my
identity. However, when I arrived home, I noticed that said Passport was no
longer inside by bag;

4. That, I exerted diligent efforts to look after said Certificate of

Registration but the same proved futile, hence the same is now considered
lost;

5. I executed this affidavit to attest to the truthfulness of the foregoing

facts

IN WITNESS WHEREOF, I hereunto set my hand this 9th of

December 2022 at Cabanatuan City.

MARGIE O. CABANSAG
Affiant

SUBSCRIBED AND SWORN to before me 9 th of December 2022 at

Cabanatuan City.

Atty. Glino Barsen G. Claudio

Administering Officer
Pursuant to RA 9406