Republic of the Philippines)

CITY OF SAN PEDRO S.S

Province of Laguna
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AFFIDAVIT

I, ALFREDO G. PANTE, of legal age, Filipino and with residential and post office
address at Unit 5 MMG Bldg. Maharlika Drive, United Brgy. San Antonio, City of San Pedro,
Laguna after having been duly sworn to in accordance with law, hereby depose and say;

1. That, I am applying for passport ;

2. That when the officer checked the previous passport applications they saw that I have
formerly applied and used a passport which is not accurate;
3. That I was not the person who previously applied and used the passport;
4. That I am never been applied and used a passport;
5. That I am executing this affidavit in order to attest to the truth of the foregoing
statements, to inform the authorities concerned and for all legal intents and purposes this
may serve best;

IN WITNESS WHEREOF, I have hereunto set my hand and affix my signature

below, this 15th day of January, 2015 at the City of San Pedro Laguna.

ALFREDO G. PANTE
Affiant

SUBSCRIBED AND SWORN to before me this 15th Day of January 2015 in City of San
Pedro Laguna. Affiant having exhibited to me her proof of Identity Voter’s I.D. with No.3425-
0310C.

Doc. No: ________

Page No.:________
Book No.:________
Series of 2014