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AFFIDAVIT OF LOSS

REPUBLIC OF THE PHILIPPINES]


QUEZON CITY ] S.S.

I, GAYLE B. NABOR, of legal age, Filipino citizen, with residence


and postal address at Blk 27 Lot 4 Phase4 Soldiers Hills4 Molino, Bacoor
Cavite City, after having been duly sworn in accordance with law, do
hereby depose and state:

1. That I am a holder of Philippine Passport issued by the


Department of Foreign Affairs, Manila, sometimes last year
2013;

2. That I used to keep the said Passport inside my closet with my


other personal belongings;

3. That on December 2016, when I looked for the said Passport, I


found out the same is missing, maybe misplaced or lost;

4. That despite my diligent effort to recover said Passport the same


proves futile

6. That I never entrusted the aforesaid Passport to anybody and


that should the same be found in the possession of anyone,
his/her possession thereof proceeds from an illegal and/or
unauthorized cause;

7. That I execute this affidavit for the purpose of requesting the


Department of Foreign Affair, Manila, to issue another Passport
in lieu of the lost one and to attest to the truth and veracity of
the foregoing facts and for whatever legal purpose/s this maybe
serve.

AFFIANT FURTHER SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto set my hand this 20 th day


of February 2017, in Quezon City, Philippines.

GAYLE B. NABOR
Affiant

SUBSCRIBED AND SWORN to before me this _____ th day of


February 2017 at Quezon City, affiant exhibiting to me her SSS ID No. .

Doc No. ______;


Page No. _____;
Book No. _____;
Series of 2017.