REPUBLIC OF THE PHILIPPINES)

DONE IN THE CITY OF BAGUIO )S.S.

_________________________________

AFFIDAVIT OF LOSS

I, GLENN, of legal age, single, American and Filipino citizen, a resident of No. 1, Purok
5, Bakakeng Norte, Baguio City, after having been sworn to in accordance with law, hereby
depose and say that:

1. I am a holder of a Philippine Passport and an American passport by reason of my

being a dual citizen of both Philippines and America;

2. Last Friday, May 12, 2017, I was supposed to fly to the United States but at the NAIA
Terminal 1 Airport, I and several other dual citizens were refused to board the plane
for the reason that we did not have with us our Certificate of Identification which was
supposed to be issued by the Bureau of Immigration, Manila;

3. I thus had to go back to Go Hotel, Mandaluyong City and because of the many
luggage I had to carry alone, I did not notice that I did not anymore have with me my
Philippine Passport;

4. I may have lost my Philippine Passport while I was aboard the taxicab en route to my
hotel as I only discovered its loss when I went to the Bureau of Immigration to secure
the Certificate of Identification which was required of me to present at the airport;

5. My Philippine Passport was never confiscated nor surrendered to the authorities for
violation of law whatsoever;

6. I am executing this Affidavit to attest to the truthfulness and veracity of the foregoing
facts for the purpose of reporting the loss of Philippine Passport, cause its
replacement and for all legal intents and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 15 th day of May 2017 in the
City of Baguio, Philippines.

GLENN PILI
Affiant