REPUBLIC OF THE PHILIPPINES )

City__________________ ) SS.

AFFIDAVIT OF LOSS

I, Estela T. Pangalinon, of legal age and residing at 25 B Chico Street Zone 1 North
Signal Taguig City, under oath, state:

1. THAT while I was riding a jeepney traversing the usual portion of my daily commute
to and from my workplace, I was carrying my bag which contained my Passport,
various other identifications and other personal belongings;

2. THAT, as I arrived home and after checking my bag, my Passport and other
identifications were lost;

3. THAT I exerted diligent efforts to locate my Passport and other identifications but to
no avail and I therefore considered the same as lost and can no longer be found;

4. THAT I am executing this Affidavit to attest to the truth of the foregoing facts and to
use the same for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I hereunto affix my signature this 10 August 2023 at

__________________.

Estela T. Pangalinon
Affiant

SUBSCRIBED AND SWORN to before me this _______________ at

__________________, Affiant exhibiting to me her __________ bearing No.
____________ issued at ______________ valid until ________________.

Doc No. ______;

Page No. ______;
Book No. ______;
Series of 2023.