REPUBLIC OF THE PHILIPPINES)

QUEZON CITY ) S.S

AFFIDAVIT OF DAMAGED PASSPORT

I, MARIA FE HEPO PALLAR, Filipino, of legal age, single presently residing at VERBENA
STREET WEST FAIRVIEW QUEZON CITY, after having sworn in accordance with law, do
hereby depose and states that:

1. I was issued on JUNE 03, 2023 by the Department of Foreign Affairs in Manila,
Metro Manila, a Philippine Passport with Serial No. P4321607C;

2. That said passport was damaged on or about September 17, 2023, while I was
cleaning the house, I noticed something among my nephews holding something
that had be written on it and the other pages were torn out and I was curious so I
looked at what it was and to my great surprise it turned out to be my passport.

3. The damage caused to my passport was in advertent and unintentional;

4. I am executing this affidavit to declare the factual circumstances as to how said

passport was damaged beyond further use and to support my present
application for a new passport to replace the one that is damaged; and

5. Each and all of the facts stated here are true and correct, and made with full
awareness that I may be held liable for perjury and have the passport issued in
my name cancelled if any misrepresentation or falsehoods are found to have
been made in this affidavit Further Affiant sayeth not.

IN WITNESS WHEREOF, I hereby affix my signature to this affidavit herein the

Municipality of Quezon, Philippines.

MARIA FE HEPO PALLAR

Affiant

SUBSCRIBED AND SWORN TO before me this 18th day of September, 2023. Affiant
showing to me

NOTARY PUBLIC
Doc No. _______;
Page No. _______;
Book No._______;
Series of 2023