REPUBLIC OF THE PHILIPPINES)

CITY OF ILOILO) S.S.

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

AFFIDAVIT OF MUTILATION
I, JUAN IBAÑEZ, JR., of legal age, married, Filipino, and a resident of Zone 3
Brgy. Bongco, Pototan, Iloilo, Philippines, after having been sworn to in accordance with
law, hereby depose and say that:

1. I am the holder of Passport No. FF 457168, issued on 24 March 2000 and

valid until 24 March 2005, issued by the Department of Foreign Affairs (DFA) Consular
Office, Iloilo City;

2. Since the time of its expiry, I have been keeping the said passport inside a bag
where my other important papers are also kept;

3. Last year when I was intending to renew my passport in order for me to visit
my son in Thailand, I found out that my said passport damaged due to prolonged
accidental exposure to rainwater dripping from a damaged roofing in our home. Another
probable reason for its damage is the Typhoon Frank in 2008 which flooded the entirety
of Brgy. Bongco including our home, hence, making the said passport to be mutilated and
invalid, without my knowledge;

4. I am executing this Affidavit of Mutilation to attest to the truthfulness of the

foregoing facts and to support my request for renewal of passport with the Department of
Foreign Affairs (DFA) Consular Office, Iloilo City.

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

this _________________, in the City of Iloilo, Philippines.

JUAN IBAÑEZ, JR.

Affiant

SUBSCRIBED AND SWORN to before me this 02 August 2022, in the City of

Iloilo, Philippines, affiant exhibiting to me his (Pototan) OSCA No. 5847, as competent
proof of his identity.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2022.

728584749.doc