AFFIDAVIT OF NON-SUBMISSION OF DOCUMENT

I, ________________________________________, of legal age, ___________ citizen,

and a resident of __________________________________________, Taiwan, after being sworn
in accordance with law, hereby depose and state that:

1. I am an applicant for the:

☐Report of Birth of my child named ___________________________;
☐Retention/Reacquisition of Philippine citizenship pursuant to R.A. No. 9225;
☐Declaration of intention to renounce Philippine citizenship;

2. Among the requirements to be submitted to the MECO in support of the above-

mentioned application is a copy of
☐First passport or Travel Document of the Child/Subject (photocopy data page only)
☐Passport of Parents (valid at the time of the birth of the child) + current/valid
passports of both parents (photocopy of data page only);
☐Canceled Philippine passport of the applicant for R.A. No. 9225;
☐_________________________________________________________________;

3. I could not submit the above requirement/s because said document/s is/are not
available/ had been lost/ was/were destroyed.

IN WITNESS WHEREOF, I hereby affix my signature this _____________________ at Taipei

City, Taiwan.
_____________________________
Affiant

MANILA ECONOMIC AND CULTURAL OFFICE, TAIPEI, TAIWAN

SUBSCRIBED and SWORN to before me this _____________________, at Taipei City, Taiwan

by _______________________________________________, who is known to me by competent
evidence of identity consisting of her/his _______________________ with No. ________________
issued by ____________________ on ________________ and valid until _________________.
WITNESS MY HAND AND SEAL of the Manila Economic and Cultural Office on the date and
place first above-mentioned.

Series of 20 __________ Upon request and authority of the

Service No.___________ Department of Foreign Affairs
Republic of the Philippines
Fee Paid-NT$_________
M.R/P.R. No._________