Republic of the Philippines)

City of Makati ) s.s.

AFFIDAVIT OF LOSS

I, ______________, of legal age, Filipino, with residential address at

____________, after having been duly sworn in accordance with law, depose and
state that:

(1) My old passport issued by the Department of Foreign Affairs last year
______ with validity until _______;

(2) I cannot recall the details particularly the passport number of the said
passport;

(3) I checked my files to look for my old passport or even a copy but I
cannot find any;

(4) All diligent efforts to locate the said passport futile;

(5) This affidavit of loss is being executed for the purpose of attesting to
the foregoing facts and for whatever legal purposes it may serve best.

IN TESTIMONY WHEREOF, I have hereunto set my hand this ______ th day of

____________ at the _______________, Philippines.

Affiant

SUBSCRIBED AND SWORN to before me this ___________ day of

______________ affiant exhibiting to me his

Doc. No.
Page No.
Book No.
Series of 2023.