REPUBLIC OF THE PHILIPPINES)

CITY OF PARANAQUE..............) S.S.

AFFIDAVIT OF LOSS

I, NIKKA ERIKA M. YU, of legal age, Filipino, single and a resident of 6C -218 Chateau
Elysee Condominium - Parañaque City, Doña Soledad Ave, Parañaque City, Philippines,
Parañaque, Metro Manila Philippines, after having been duly sworn to in accordance with law,
depose and state that:
1. I am a duly lawful owner of passport bearing with Passport No. xxxx, with
the name of NIKKA ERIKA M. YU, birth date: xxx; Place of Birth:
Mandaluyong City, Metro Manila; issued at DFA Manila Branch, Date
issued: xxxx, Valid Until xxxx;

2. My passport has been inside my day to day bag for safekeeping for the
purpose of immediate need to present my passport as additional proof of
identity;

3. Sometime in November 9, 2023, I was looking for my passport inside my

bag but unable to retrieve and got lost;

4. Efforts were exerted to locate said passport, in spite of diligent search, it

could not be found and the same is now beyond recovery;

5. Said passport has not been confiscated by the DFA, or other authorized
agencies;

6. As such, I am executing this Affidavit of Loss to attest to the truth of the

foregoing and to support my application for the issuance of a new
Passport, in lieu of the one that was lost;

IN WITNESS WHEREOF, I have hereunto set my hand this this 11th day of November 2023 in
Parañaque City, Metro Manila, Philippines.

NIKKA ERIKA M. YU
Affiant

SUBCRIBED AND SWORN TO before me this this 11th day of November 2023 in Parañaque
City, Metro Manila, Philippines, affiant exhibiting to me her competent evidence of identity by
way of PHIL xxxxx issued at Manila City, Philippines.

Doc. No. ___;

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