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REPUBLIC OF THE PHILIPPINES)

CITY OF CALOOCAN )S.S.

AFFIDAVIT OF LOSS

I, RICKY ORDANZA, of legal age, single, Filipino citizen and with


residential address at No. 66 Bridgetown Street, Vista Verde North Exec. Village,
Caloocan City, after having been sworn to in accordance with law hereby depose
and state;

1. That I am a regular passport holder, having been issued by the


Department of Foreign Affairs (DFA), which passport was even
used when I traveled to Japan a couple of years ago;

2. That I kept the said passport at home together with my personal


files and school credentials;

3. That lately however, while I was looking the said passport at home
and at my previous residence, the same could not be found or
probably misplaced when we transferred our residence from
Alecon Homes to Vista Verde;

4. That despite diligent effort to locate the said passport proved futile;

5. That I am executing this affidavit in order to attest to the truth of


the foregoing facts and circumstances behind the loss of my
passport and in order to request for its replacement from the
Department of Foreign Affairs (DFA) and for whatever legal
purpose this may serve.

FURTHER AFFIANT SAYETH NAUGHT.

Done this 15th day of January, 2007 at the City of Caloocan, Philippines.

RICKY ORDANZA
Affiant

SUBSCRIBED AND SWORN to before me a Notary Public for and in the


City of Caloocan this 15th day of January, 2007.

Doc. No. ____


Page No. ____
Book No. ____
Series of 2007

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