REPUBLIC OF THE PHILIPPINES )

City of Imus ) S.S

AFFIDAVIT OF DESTRUCTION/ MUTILATION

I, SHERLYN B. DAVID, of legal age, Filipino, single, and residing at Blk 4

Lot 58 Greentown Village 2, Toclong II-B, Imus City, Cavite, after having been duly
sworn to according to law hereby depose and state:

1. That I am a holder of a Philippine Passport No. FF667461 issued on April

24, 2000, issued by the Department of Foreign Affairs in Manila;

2. That the said Passport was mutilated because it was too old and had
separated all the pages and only the first page was left;

3. I am executing this affidavit to attest to the truth of the foregoing;

4. Further, I am executing this affidavit of mutilation to support my application

for the renewal of a new Philippine Passport, instead of the one that was
mutilated and for any legal purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 8 th day of March

2024 at the City of Imus.

SHERLYN B. DAVID
Affiant
Philippine National ID
ID No: 5036-1596-3027-9143

SUBSCRIBED AND SWORN to before me this 8th day of March 2024 at the City
of Imus.
Notary Public
Doc. No.______
Page No.______

Book No._______
Series of 2024.