REPUBLIC OF THE PHILIPPINES)

CITY OF _______________ ) S.S.

x----------------------------------x

AFFIDAVIT OF LOSS

I, Maria Fe Mae Catipay, of legal age, Filipino, married and a resident of

Looc, Santander Cebu, after having been duly sworn to in accordance with law,
depose and state THAT:

1. On or about year 2012, I was issued a Philippine Passport by the Department

of Foreign A airs in Cebu;

2. Recently, I had tried to look for the said passport but the same could not be
found;

3. The last time that I could recall seeing my passport was around year 2015 at
Pasil Santander, Cebu before I transferred residency in Sitio Guac, Bangcogon,
Oslob, Cebu.

4. Despite diligent search and e orts to locate the said passport, I could not
nd the same such that I believe that it is now lost beyond recovery;

5. As such, I am executing this a davit to attest to the foregoing facts and to

support the application for the renewal and re-issuance of a new one in lieu of
the one which was lost.

IN WITNESS WHEREOF, I have hereunto set my hand this ___________________ in

_________________________, Philippines.

Maria Fe Mae Catipay

A ant

SUBCRIBED AND SWORN TO before me this ___________________ in

_________________, Philippines, a ant exhibiting to me his valid proof of
identi cation.

Doc. No. _____;

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