Republic of the Philippines )

Province of Zamboanga Del Sur)

City of Pagadian ) S.S.
--------------------------------------------------x

AFFIDAVIT OF LOSS OF PASSPORT

I, LUCIO P. ALBARACIN, Filipino of legal age, married and presently residing

at Lumbog, Margosatubig, Zamboanga Del Sur, after having been duly sworn to in
accordance with law, hereby depose and state: That –
1. I am holder of Passport No. EC8360775 issued on July 20, 2016.
2. Sometime around April 2023, I noted that the said passport was missing.
3. To my knowledge, my passport was lost when I transferred my place of work
from Manila, Philippines to Pagadian City, way back 2019;
4. It took great pains to look for the said passport but to no avail and it believe it
is now beyond recovery;
5. I am executing this affidavit to attest to the truthfulness of the foregoing and
to in support of my application for a new passport in lieu of the lost one.

IN WITNESS WHEREOF, I have hereunto signed my name below this day ____
of ________________ at Pagadian City, Zamboanga Del Sur, Philippines.

LUCIO P. ALBARACIN
Affiant

SUBSCRIBED AND SWORN to before me, this ______ of ________________, in

the City of Pagadian, Province of Zamboanga Del Sur, Philippines. Affiant exhibited his
____________________ issued by ____________.

Doc No. _______

Page No. ______
Book No. ______
Series of _______