REPUBLIC OF THE PHILIPPINES )

DASMARIÑAS CITY, CAVITE ) S.S.

AFFIDAVIT OF LOSS
I, JENNIFER POLO LAGMAY, of legal age, Filipino Citizen, single, and with
postal and residence address Blk 67 Lot 23 Ph4, Silicon St. Golden City, Anabu II-F, Imus City,
Cavite, after having been duly sworn to in accordance with law, hereby depose and say:

That I am the mother of COLLIN BRAYNT L. COSTELLO, who was born November
20, 2008 and residence address at the same address;

That my son, COLLIN BRAYNT L. COSTELLO is the owner/holder of the

PHILIPPINE PASSPORT issued by Department of Foreign Affairs (DFA) -
IRELAND;

That unfortunately, the said passport can no longer be found as it was accidentally
misplaced while I was processing documents for DFA at SM Pala Pala on June 07, 2023;

That despite of diligent efforts, the said passport cannot be found and it was considered as
lost;

That the said passport has not been encumbered, sold, pledged, assigned, alienated,
transferred, donated, or given as collateral for any debt or obligation to or in favor of any
person or entity;

That I understand that my declaration of the above-mentioned passport as lost shall be

constructed as satisfactory proof that the passport was lost, in compliance with section 15
of RA 8239 of the Philippine Passport Act of 1996;

That I am executing this affidavit to attest to the truth of the foregoing facts for all legal
intents and purposes.

IN WITNESS WHEREOF, I have hereunto set my hand this 29th day of June 2023 at
Dasmarinas City, Cavite, Philippines.

JENNIFER POLO LAGMAY

Affiant

SUBSCRIBED and SWORN to before me on the date and place above-written. Affiant
exhibiting to me his/her Philippine Passport: P6199803A

Doc. No. 351

Page No. 71
Book No. 12
Series of 2023