Republic of the Philippines)

City of Cebu )
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AFFIDAVIT OF LOSS
I, CHARLANE MARIE ALIPIO, of legal age, single, Filipino Citizen, and a
resident of Apple One, Banawa Heights Subdivision, Brgy. Guadalupe Cebu City
Cebu Philippines , after having been fully sworn to in accordance with law do
hereby depose and state:
1. That I am the biological mother of Levent Nikolas Samual Alipio Howarth
who was born on April 23, 2023;

2. That I applied a Philippine passport identification card for him in the

Department of Foreign Affairs (DFA) Cebu branch and said passport was
issued to me on May 4, 2023;

3. That the said passport was in my custody which I kept in my travelling bag;

4. That around last week of June 2023, I noticed that the said passport of my
child was not anymore in the travelling bag where it was kept;

5. That I believe that the said passport was just misplaced and despite diligent
efforts exerted the said passport was not found;

6. That for being beyond recovery, I considered the said Philippine passport
identification card as lost for all legal intent and purposes;

7. That I execute this Affidavit in order to attest to the truth the foregoing
facts of its loss and to request the Department of Foreign Affairs (DFA) for
its new issuance in lieu of the lost one; for other legal purposes that this
Affidavit may serve.

In witness whereof, I have hereunto set my hand this_______________in Cebu

City Cebu Philippines.
CHARLANE MARIE ALIPIO
( AFFIANT)

Subscribed and sworn to before me this_____________in Cebu City Cebu

Philippines. Affiant showed to me her Philippine National Identification Card #
4369-2071-6354-0290 as competent proof of her identity.