Republic of the Philippines )

City of Manila ) S.S.

AFFIDAVIT OF MUTILATION
(Philippine Passport)

I, ANETTE CLAUDINE B. AREGLO, of legal age, Filipino, married and with

residence at Blk 4 Lot 18 Talisay St. Westwood Homes Alapan 1 B Imus Cavite, Philippines ,
after having been duly sworn to in accordance with law, do hereby depose and state;

That I am the true and lawful owner of a PHILIPPINE PASSPORT issued at DFA
NCR WEST of which is more particularly described as follows:

Surname : AREGLO
Given Name : ANETTE CLAUDINE
Middle Name : BALDOVINO
Passport No. : P4357819B
Date of Issue : January 10, 2020 – January 09, 2030

My PHILIPPINE PASSPORT was wet in the house due to typhoon.

That I am executing this foregoing instrument in order to attest to the truth of the
mutilation so that a new one may be issued to me in lieu of the mutilated Passport and for
whatever legal purposes this document may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 12 th day of October 2023
in the City of Manila, Philippines.

ANETTE CLAUDINE B. AREGLO

Affiant

SUBSCRIBED AND SWORN to before me, this 12th day of October 2023 in City of
Manila, with affiant exhibiting her Philippine Passport with No. P4357819B issued at DFA NCR
WEST, Philippines.

Doc No.
Page No.
Book No.
Series of 2023