(Affidavit of Loss Passport)

Republic of the Philippines)

Province of ____________________) S.S.
City/Municipality of _____________)
x - - - - - - - - - - - - - x
AFFIDAVIT OF LOSS
I, _____________,of legal age, Filipino, (single / married /
widow), and a resident of _____________, Philippines, after
having been duly sworn in accordance with law, hereby depose and
state:
That on _____________, I was issued a Philippine Passport by the
Department of Foreign Affairs in _____________;
That recently I had tried to look for the said passport but the
came could not be found;
That despite diligent search and efforts to locate the said
passport, I could not find the same such that I now believe that
it is now lost beyond recovery;
As such, I am executing this Affidavit of Loss to attest to the
truth of the foregoing and to support the application for the
issuance of new one in lieu of the one which was lost.
IN WITNESS WHEREOF, I have hereunto set my hand this
_____________ at _____________, Philippines.
AFFIANT
(JURAT)