REPUBLIC OF THE PHILIPPINES )

CITY OF MANILA )S.S.

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

AFFIDAVIT OF LOSS

I, _________, of legal age, Filipino, with address at _____________, after

having been duly sworn to in accordance with law, hereby depose and say that:

1. I am a holder of the following identification cards:

a. ID
b. BOOKLET
c. ATM CARD

2. Unfortunately, sometime May 2017 , my said Growvite ID, Booklet and

Union Bank ATM Card were lost inside my residence;

3. That despite effort to secure/locate the same, all my efforts were futile
thus the same should now be considered as lost;

4. I am executing this affidavit to attest to the truth of the foregoing facts

for all its legal intents, effects, consequences and purposes.

IN WITNESSETH WHEREOF, I have hereunto affix my signature on this

June 11, 2018 at the City of Manila.

Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, this June 11, 2018 at the
City of Manila, affiant with her ______

Doc. No.
Page No.
Book No.
Series of 2018
REPUBLIC OF THE PHILIPPINES)
LAS PIÑAS CITY )S.S.

AFFIDAVIT OF LOSS-PASSPORT

I, NOEL RIVERA ANTONIO, of legal age, Filipino, and resident of #721 San
Francisco St., Ilaya, Las Pinas City, after having been duly sworn to in accordance
with law, hereby depose and say that:

I am a holder of Philippine passport issued by the Philippine Embassy in

Norway in which, contained the following personal information:

BIRHTDATE : December 27, 1962

SEX : Male
NATIONALITY : Filipino

2. On or about August 30, 2014, I rode on a public utility vehicle (jeepney)

from Alabang to Las Pinas City, and upon reaching home, I discovered that the
envelope containing said passport was missing, only then I remember that the
said envelope was inadvertently left behind in the public utility vehicle (jeepney).

3. Despite of diligent efforts to look for said passport, all such efforts proved
futile and in vain, thus, I am declaring the loss of my said passport.

4. Said passport have never lent or allowed any person to use the said
passport nor has such passport been confiscated by law enforcement agencies or
the subject of any pending litigation.

5. I am executing this affidavit to attest to the truth of the foregoing facts

for all its legal intents, effects, consequences and purposes.

NOEL RIVERA ANTONIO

Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, this September 17, 2014 at

Las Pinas City.

Doc. No. 154

Page No. 32
Book No. 87
Series of 2014.
REPUBLIC OF THE PHILIPPINES)
LAS PIÑAS CITY )S.S.

REPUBLIC OF THE PHILIPPINES)

LAS PIÑAS CITY )S.S.

AFFIDAVIT OF LOSS-PASSPORT

I, EUGENIE M. LUSPO, of legal age, Filipino, and resident of #18 F. Cruz

St., BF Homes, Phase 3, Paranaque City, after having been duly sworn to in
accordance with law, hereby depose and say that:

I am a holder of expired Philippine passport issued by the Department of

Foreign Affairs in Manila on or year 2012, in which, contained the following personal
information:

BIRHTDATE : May 24, 1968

SEX : Female
NATIONALITY : Filipino

2. My said passport inadvertently got lost.

3. Despite of diligent efforts to look for said passport, all such efforts proved
futile and in vain, thus, I am declaring the loss of my said passport.

4. Said passport have never renewed thereafter and never lent or allowed
any person to use the said passport nor has such passport been confiscated by law
enforcement agencies or the subject of any pending litigation.

5. I am executing this affidavit to attest to the truth of the foregoing facts

for all its legal intents, effects, consequences and purposes.

EUGENIE M. LUSPO
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, this August 28, 2014 at Las
Pinas City.

Doc. No. ____

Page No. ____
Book No. ____
Series of 2014.
REPUBLIC OF THE PHILIPPINES)
LAS PIÑAS CITY )S.S.

AFFIDAVIT OF LOSS-PASSPORT

I, MARY-LYNNE O. BASAS, of legal age, Filipino, and resident of Block 32

Lot 80A Ozaeta St., B.F. Resort Village, Vista Grande, Pamplona, Las Pinas City,
after having been duly sworn to in accordance with law, hereby depose and say
that:

I am a holder of expired Philippine passport issued by the Philippine Embassy

in Kingdom of Saudi Arabia on or about year 1985 when I was infant, in which,
contained the following personal information:

BIRHTDATE : June 29, 1985

SEX : Female
NATIONALITY : Filipino

2. My said passport inadvertently got lost.

3. Despite of diligent efforts to look for said passport, all such efforts proved
futile and in vain, thus, I am declaring the loss of my said passport.

4. Said passport have never renewed thereafter and never lent or allowed
any person to use the said passport nor has such passport been confiscated by law
enforcement agencies or the subject of any pending litigation.

5. I am executing this affidavit to attest to the truth of the foregoing facts

for all its legal intents, effects, consequences and purposes.

MARY-LYNNE O. BASAS
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, this August 1, 2014 at Las

Pinas City.

Doc. No. ____

Page No. ____
Book No. ____
Series of 2014.

REPUBLIC OF THE PHILIPPINES)

LAS PIÑAS CITY )S.S.

AFFIDAVIT OF LOSS-PASSPORT

I, GRACE QUIAMBAO BAYAUA, of legal age, Filipino, and resident of ##28

Pink Rose St., Manuela Subd., Pamplona Tres, Las Pinas City, after having been
duly sworn to in accordance with law, hereby depose and say that:

I am the biological mother of minor GWENEVIE QUIAMBAO BAYAUA, a

holder and owner of Philippine passport issued by the Department of Foreign Affairs
in Manila, in which, inter alia, contained the following personal information:

BIRHTDATE : March 28, 2003

SEX : Female
NATIONALITY : Filipino
PASSPORT NO.: LL973160 –issued on 10/7/2003 at DFA, Manila

2. Said passport inadvertently got lost.

3. Despite of diligent efforts to look for said passport, all such efforts proved
futile and in vain, thus, I am declaring the loss of my said passport.

4. Said passport have never lent or allowed any person to use the said
passport nor has such passport been confiscated by law enforcement agencies or
the subject of any pending litigation.

5. I am executing this affidavit to attest to the truth of the foregoing facts

for all its legal intents, effects, consequences and purposes including for the
issuance to my said daughter of another passport in lieu of the one that was lost.

GRACE QUIAMBAO BAYAUA

Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, this February 28, 2014 at Las
Pinas City.

Doc. No. ____

Page No. ____
Book No. ____
Series of 2014.